Local cutaneous recurrence after conservative excision of malignant melanoma.

We examined the risk factors for the development of local recurrence in patients treated with a conservative wide local excision, which was defined as being less than the historical 5-cm margin. There were 118 patients with clinical stage I disease followed up for a minimum of 60 months or until death. The extent of wide local excision varied from 0.6 to 8.5 cm. The majority (76.3%) had a resection margin of 30 mm or less. Four patients (3.4%) had local recurrence within 5 cm of the primary closure scar or skin graft edge. The primary lesion in the patients with local recurrence had deeper invasion and larger diameters than the lesion in patients who did not have local recurrence. Other recognized risk factors, such as ulceration, satellitosis , and unrecognized subclinical stage II disease, at the time of initial diagnosis were noted in the patients eventually displaying local recurrence. Tumor aggressiveness was recognized. The patients who had local recurrence had excisions with wider margins (mean, 4.75 cm; range, 2.5 to 8.5 cm) than the patients without local recurrence (mean, 2.87 cm; range, 0.6 to 6.0 cm). A tumor-field effect did not contribute to local recurrence.