Can we reduce excision margins for head and neck melanoma? A 12-year retrospective study

Published:November 02, 2020DOI:


      Although wide local excision is the standard treatment for primary melanoma, the surgical margin remains controversial. Melanomas of the head and neck exhibit higher recurrence rates and worse prognosis than lesions in other body locations, and their close proximity to critical anatomical and functional structures means that wide excision margins are often not feasible. Surgeons must therefore achieve a balance of oncological safety and functional and aesthetic needs. The aim of this study was to retrospectively analyse melanoma data over a 12-year period at a large skin surgery unit to identify potential differences in outcomes in patients who had reduced wide local excision margins for primary head and neck melanoma. The study would provide further evidence for the need for large randomised prospective trials to reduce excision margins for head and neck melanoma. Local cancer network data were retrospectively analysed over a period of 12 years (2008-2019). Data included site, initial stage, multidisciplinary team (MDT) meeting recommendations for excision margins and the actual wide local excision margin taken, recurrence rate, and disease-specific and absolute survival. A total of 222/305 patients (73%) had the recommended excision margin, while in 27% margins were reduced due to anatomical or functional considerations. Recurrence rates were similar (recommended 11.7% vs narrow 13.3% excision margins) (p = 0.64). The mean follow-up time for all patients was 48.5 months. In aesthetically and functionally sensitive areas of the head and neck, wide local excision margins need to be carefully considered after MDT discussion and discussion with the patient. This study suggests the need for further multicentre trials to address the uniqueness of head and neck melanoma.


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        • Macbeth F.
        • Newton-Bishop J.
        • O’Connell S.
        • et al.
        Melanoma: summary of NICE guidance.
        BMJ. 2015; 351: h3708
        • Marsden J.R.
        • Newton-Bishop J.A.
        • Burrows L.
        • et al.
        Revised UK guidelines for the management of cutaneous melanoma 2010.
        J Plast Reconstr Aesthet Surg. 2010; 63: 1401-1419
        • Veronesi U.
        • Cascinelli N.
        • Adamus J.
        • et al.
        Thin stage I primary cutaneous malignant melanoma. Comparison of excision with margins of 1 or 3 cm.
        N Engl J Med. 1988; 318: 1159-1162
        • Veronesi U.
        • Cascinelli N.
        Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma.
        Arch Surg. 1991; 126: 438-441
        • Balch C.M.
        • Soong S.
        • Ross M.I.
        • et al.
        Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial.
        Ann Surg Oncol. 2000; 7: 87-97
        • Balch C.M.
        • Soong S.J.
        • Smith T.
        • et al.
        Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas.
        Ann Surg Oncol. 2001; 8: 101-108
        • Larson D.L.
        • Larson J.D.
        Head and neck melanoma.
        Clin Plast Surg. 2010; 37: 73-77
        • Fisher S.R.
        • Seigler H.F.
        • George S.L.
        Therapeutic and prognostic considerations of head and neck melanoma.
        Ann Plast Surg. 1992; 28: 78-80
        • Lo M.C.
        • Heaton M.J.
        • Snelling A.
        • et al.
        Reconstructive burden and financial implications of wider excision margins for invasive primary cutaneous melanoma.
        J Plast Reconstr Aesthet Surg. 2020; 73: 313-318
        • Marchetti Cautela J.
        • Mannocci A.
        • Reggiani C.
        • et al.
        Identifying the factors that influence surgeon’s compliance with excisional margins of non-melanoma skin cancer.
        PLoS One. 2018; 13e0204330
        • Barzilai D.A.
        • Singer M.E.
        The potential impact on melanoma mortality of reducing rates of suboptimal excision margins.
        J Invest Dermatol. 2003; 120: 1067-1072
        • Rawlani R.
        • Rawlani V.
        • Qureshi H.A.
        • et al.
        Reducing margins of wide local excision in head and neck melanoma for function and cosmesis: 5-year local recurrence-free survival.
        J Surg Oncol. 2015; 111: 795-799
        • Angeles C.V.
        • Wong S.L.
        • Karakousis G.
        The landmark series: randomized trials examining surgical margins for cutaneous melanoma.
        Ann Surg Oncol. 2020; 27: 3-12
        • Moncrieff M.D.
        • Gyorki D.
        • Saw R.
        • et al.
        1 versus 2-cm excision margins for pT2-pT4 primary cutaneous melanoma (MelMarT): a feasibility study.
        Ann Surg Oncol. 2018; 25: 2541-2549
        • Keung E.Z.
        • Gershenwald J.E.
        The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care.
        Expert Rev Anticancer Ther. 2018; 18: 775-784
        • Sladden M.J.
        • Nieweg O.E.
        • Howle J.
        • et al.
        Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma.
        Med J Aust. 2018; 208: 137-142
        • Davis-Malesevich M.V.
        • Goepfert R.
        • Kubik M.
        • et al.
        Recurrence of cutaneous melanoma of the head and neck after negative sentinel lymph node biopsy.
        Head Neck. 2015; 37: 1116-1121