Is a Wider Margin (2 cm vs. 1 cm) for a 1.01-2.0 mm Melanoma Necessary?
Is a Wider Margin (2 cm vs. 1 cm) for a 1.01-2.0 mm Melanoma Necessary?
复制标题
DOI：
10.1245/s10434-016-5167-6
复制
发表时间：
2016-07
影响因子：
3.7
通讯作者：
Zager JS
中科院分区：
文献类型：
--
作者：
Doepker MP;Thompson ZJ;Fisher KJ;Yamamoto M;Nethers KW;Harb JN;Applebaum MA;Gonzalez RJ;Sarnaik AA;Messina JL;Sondak VK;Zager JS
目前NCCN建议，对于深度在1.01-2 mm之间的黑色素瘤患者，切除边缘为1-2 cm径向边缘。我们试图确定切缘宽度是否对局部复发（LR）、疾病特异性生存率（DSS）和伤口闭合类型有影响。2008年至2013年期间，在一家机构对1.01-2.0 mm黑色素瘤进行了评价。所有患者的切缘均为1或2 cm。我们确定了965例边缘1 cm（n=302，31.3%）或2 cm（n=663，68.7%）的患者。中位年龄为64岁，592例（61.3%）为男性。32.5%和48.7%的头颈部和四肢患者与18.9%的躯干患者有1 cm的边缘（p<0.001）。1 cm和2 cm切缘的LR分别为0.6%和1.5%（p=NS）。对于1 cm切缘和2 cm切缘，5年DSS分别为87%和85%（p=NS）。在单变量分析中，Breslow厚度、头部和颈部黑色素瘤、淋巴血管浸润（LVI）和前哨淋巴结活检（SLNB）状态可显着预测LR，但在多变量分析中，只有位置和SLNB状态与LR相关。边缘宽度对LR或DSS不显著。更宽的边缘与更频繁的移植物或皮瓣使用仅在头部和颈部（p=0.025）。我们的数据显示，选择性地使用1 cm的窄边缘并没有增加局部复发的风险或减少DSS。避免2 cm的边缘可能会减少在头颈部使用移植物/皮瓣的需求。
The current NCCN recommendation for resection margins in patients with melanomas between 1.01–2 mm deep is a 1–2 cm radial margin. We sought to determine if margin width had an impact on local recurrence (LR), disease-specific survival (DSS), and type of wound closure. 1.01–2.0 mm melanomas were evaluated at a single institution between 2008 and 2013. All patients had a 1 or 2 cm margin. We identified 965 patients that had a 1 cm (n=302, 31.3%) or 2 cm margin (n=663, 68.7%). Median age was 64 and 592 (61.3%) were male. 32.5% and 48.7% of head and neck and extremity patients had a 1 cm margin vs. 18.9% of trunk pts (p<0.001). LR was 0.6% and 1.5% for a 1 and 2 cm margin, respectively (p=NS). Five-year DSS was 87% for a 1 cm margin and 85% for a 2 cm margin (p=NS). Breslow thickness, melanoma on the head and neck, lymphovascular invasion (LVI) and sentinel lymph node biopsy (SLNB) status significantly predicted LR on univariate analysis, however only location and SLNB status were associated with LR on multivariate analysis. Margin width was not significant for LR or DSS. Wider margins were associated with more frequent graft or flap use only on the head and neck (p=0.025). Our data show selectively using a narrow margin of 1 cm did not increase the risk of local recurrence or decrease DSS. Avoiding a 2 cm margin may decrease the need for graft/flap use on the head and neck.