Surgical Excision of Primary Melanoma

Melanoma skin cancer ---> primary melanoma ---> melanoma treatment ---> melanoma surgery

The primary purpose of a melanoma excision is to prevent local recurrence due to persistent disease. For melanoma in situ, excision margins of 0.5 to 1 cm are indicated. For invasive melanoma, wide excision of the primary tumor, with margins generally ranging from 1 to 2 cm, is indicated for local control. The optimal margin width remains somewhat controversial. The historical approach of excising all primary melanomas with a 3- to 5-cm margin is extinct. At least five randomized controlled trials failed to demonstrate a difference in overall survival or local recurrence with narrow (1 to 2 cm) versus wide (3 to 5 cm) margins. Of note, one trial demonstrated an increased risk of locoregional recurrence with 1 versus 3 cm margins for melanoma more than 2 mm thick.25 Hopefully, results from future randomized prospective trials will demonstrate how narrow a margin is truly safe and efficacious. Until more definitive data become available, current consensus guidelines recommend margins of 1 cm for melanoma of 1 mm or less thick, 1 to 2 cm for 1 to 2 mm thick, and at least 2 cm for greater than 2 mm thick.