Buja Alessandra, Rugge Massimo, Trevisiol Chiara, Zanovello Anna, Dall'Olmo Luigi, Zorzi Manuel, Vecchiato Antonella, Del Fiore Paolo, Paiola Matteo, Rossi Carlo Riccardo, Mocellin Simone
Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
Department of Medicine-DIMED, Surgical Pathology and Cytopathology, University of Padova, Padua, Italy.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf042.
The impact of surgical excision margin size on the survival of patients with cutaneous melanoma (CM) is controversial. The aim of this study was to assess the impact of excision margins on patient outcomes.
This retrospective population-based follow-up study analysed data from patients presenting with CM without extranodal disease. The linear distance of CM from the excision margin was assessed microscopically. Regarding overall and melanoma-specific survival estimates, Kaplan-Meier analysis, the Cox proportional hazards model, and the subdistribution hazard ratio of the Fine-Gray model were applied.
Of 3262 patients, a total of 2698 (82.7%) with pathological (p) T1-2 and 564 (17.3%) with pT3-4 CM underwent wide local excision. Multivariable analyses, adjusting for melanoma incidence cohort, age, sex, anatomical site, ulceration, histotype, mitotic count, and tumour-infiltrating lymphocytes, demonstrated that, in pT1-2 CM, surgical excision > 1.1 cm resulted in significant CM-specific survival benefit. In pT4 disease, a CM distance to the surgical margins of < 1.6 cm significantly lowered CM-specific survival.
This population-based study conducted in real-world clinical practice found that the prognosis of patients with pT1-2 CM may benefit from excision margins > 1.1 cm. In pT3-4 CM, margins < 1.6 cm were significantly associated with lower CM-specific survival rates. These findings highlight the need for further prospective studies to evaluate the safety of surgical excision margins in managing primary CM.
手术切缘大小对皮肤黑色素瘤（CM）患者生存的影响存在争议。本研究旨在评估切缘对患者预后的影响。
这项基于人群的回顾性随访研究分析了无淋巴结外疾病的CM患者的数据。通过显微镜评估CM距切缘的线性距离。在总体生存和黑色素瘤特异性生存估计方面，应用了Kaplan-Meier分析、Cox比例风险模型以及Fine-Gray模型的亚分布风险比。
3262例患者中，共有2698例（82.7%）病理（p）T1-2期和564例（17.3%）pT3-4期CM患者接受了广泛局部切除。多变量分析对黑色素瘤发病率队列、年龄、性别、解剖部位、溃疡、组织学类型、有丝分裂计数和肿瘤浸润淋巴细胞进行了校正，结果表明，在pT1-2期CM中，手术切缘>1.1 cm可带来显著的黑色素瘤特异性生存获益。在pT4期疾病中，如果CM距手术切缘<1.6 cm，则黑色素瘤特异性生存显著降低。
这项在实际临床实践中开展的基于人群的研究发现，pT1-2期CM患者的预后可能受益于>1.1 cm的切缘。在pT3-4期CM中，<1.6 cm的切缘与较低的黑色素瘤特异性生存率显著相关。这些发现凸显了进一步开展前瞻性研究以评估手术切缘在原发性CM治疗中安全性的必要性。
