Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?

In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with...

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Bibliographic Details
Published inJournal of clinical medicine Vol. 9; no. 7; p. 2266
Main Authors Ito, Takamichi, Kaku-Ito, Yumiko, Wada-Ohno, Maiko, Furue, Masutaka
Format Journal Article
LanguageEnglish
Published Basel MDPI AG 16.07.2020
MDPI
Subjects
acral lentiginous melanoma
Biopsy
Clinical medicine
Clinical outcomes
Lymphatic system
Melanoma
Patients
prognosis
Skin & tissue grafts
Skin cancer
Software packages
surgery
United States > US
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Summary:In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with narrow margins (N-group). A total of 65 patients underwent narrow-margin excision. Positive margin status or local recurrence rarely occurred regardless of the excision margins, whereas fatal events frequently occurred, particularly among the patients with T4 melanoma. The mortality rates of N- and R-group with T1–3 melanomas were similar (1.36 and 1.28 per 100 person-years, respectively). However, patients with T4 melanoma treated with narrow-margin excision had a higher mortality rate (11.44 vs. 5.03 per 100 person-years). Kaplan–Meier analyses showed a worse prognosis in the N-group (p = 0.045) but this group had thicker Breslow thickness (4.21 mm vs. 2.03 mm, p = 0.0013). A multivariate analysis showed that Breslow thickness was an independent risk factor, but surgical margin was not a risk factor for melanoma-specific survival or disease-free survival. In conclusion, although we could not find a difference between the narrow-margin excision and recommended-margin excision in this study, we suggest following current recommendations of guidelines. Our study warrants the prospective collection of data on acral melanoma to better define the prognosis of this infrequent type of melanoma.
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ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9072266