Mayo Clinic Consensus Recommendations for the Depth of Excision in Primary Cutaneous Melanoma

• Published in: Mayo Clinic proceedings Vol. 86; no. 6; pp. 522 - 528
• Main Authors: Grotz, Travis E., MD, Markovic, Svetomir N., MD, PhD, Erickson, Lori A., MD, Harmsen, William S., MS, Huebner, Marianne, PhD, Farley, David R., MD, Pockaj, Barbara A., MD, Donohue, John H., MD, Sim, Franklin H., MD, Grant, Clive S., MD, Bagaria, Sanjay P., MD, Shives, Thomas C., MD, Balch, Charles M., MD, Jakub, James W., MD
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01.06.2011; Mayo Foundation; Elsevier, Inc; Elsevier Limited; Mayo Foundation for Medical Education and Research
• Subjects: Arizona; Biological and medical sciences; Care and treatment; Clinical Trials as Topic; Consensus; Dermatology; Development and progression; Diagnosis; Diagnosis and Treatment Guidelines; Florida; General aspects; Health Care Surveys; Humans; Internal Medicine; Medical sciences; Melanoma; Melanoma - pathology; Melanoma - surgery; Minnesota; Neoplasm Recurrence, Local - prevention & control; Practice Patterns, Physicians' - statistics & numerical data; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Surgical Procedures, Operative - methods; Tumors of the skin and soft tissue. Premalignant lesions; Florida; Minnesota; Arizona; United States; Clinic; Medicine; Skin disease; Excision; Primary; Malignant tumor; Consensus; Depth; Recommendation; Cancer; Skin cancer
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/mcp.2011.0059

Currently, no data from randomized controlled clinical trials are available to guide the depth of resection for intermediate-thickness primary cutaneous melanoma. Thus, we hypothesized that substantial variability exists in this aspect of surgical care. We have summarized the literature regarding depth of resection and report the results of our survey of surgeons who treat melanoma. Most of the 320 respondents resected down to, but did not include, the muscular fascia (extremity, 71%; trunk, 66%; and head and neck, 62%). However, significant variation exists. We identified variability in our own practice and have elected to standardize this common aspect of routine surgical care across our institution. In light of the lack of evidence to support resection of the deep muscular fascia, we have elected to preserve the muscular fascia as a matter of routine, except when a deep primary melanoma or thin subcutaneous tissue dictates otherwise.