CHICAGO–The previously reported association between an increase in locoregional relapse of high risk melanoma and narrow excision margins has resulted in a significant increase in melanoma-specific mortality, research presented at the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting in Chicago, Illinois, have shown.
“The initial report published in the New England Journal of Medicine in 2004 showed a significant decrease in locoregional relapse with wide margins,” said Andrew Hayes, MA, MBBS, PhD, surgical oncologist at the Sarcoma and Skin Units at The Royal Marsden Hospital in the United Kingdom.
For the study, researchers enrolled 900 patients with primary cutaneous melanoma 2 mm or more in Breslow thickness and randomly assigned them to undergo a 1 cm or 3 cm excision.
Results showed that at a median follow up of 8.8 years, 494 patients have died, where 359 deaths were because of melanoma (194 melanoma deaths in the 1 cm arm and 165 in the 3 cm arm).
Researchers determined that the relative rate of melanoma death was about 24% higher in the 1 cm group compared with the 3 cm group (HR: 1.24; 95% CI: 1.00,1.52; P=0.05) based on univariable and multivariable analyses.
The study also showed that there was no statistically significant difference in the number of overall deaths between the two groups (253 in the 1 cm group versus 241 in the 3 cm group; HR: 1.14; 95% CI: 0.96,1.36; P=0.14).
With respect to subgroup analyses, Dr. Hayes said, “We found no strong evidence that a poorer prognosis associated with a 1 cm margin of excision was specific to a particular subgroup of patients.”
What still needs to be addressed, Dr. Hayes stated, is “if there is a causal rather than correlative relationship between locoregional failure and worse melanoma-specific survival, how would the modern management of regional lymph nodes impact melanoma survival for a 1 cm excision.”
1. Hayes AJ, Maynard L, A’Hern R, et al. Long term follow up of survival in a randomised trial of wide or narrow excision margins in high risk primary melanoma.
J Clin Oncol. 2015;33:(suppl; abstr 9001).