Alastair D MacKenzie Ross1,2, Lauren E Haydu1,3, Michael J Quinn1,3,4, Robyn P M Saw1,3,4, Kerwin F Shannon1,3,4, Andrew J Spillane1,3, Jonathan R Stretch1,3,4, Richard A Scolyer1,3,5, John F Thompson6,7,8. 1. Melanoma Institute Australia, North Sydney, NSW, Australia. 2. Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK. 3. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. 4. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 5. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 6. Melanoma Institute Australia, North Sydney, NSW, Australia. john.thompson@melanoma.org.au. 7. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. john.thompson@melanoma.org.au. 8. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. john.thompson@melanoma.org.au.
Abstract
BACKGROUND: At presentation, most primary cutaneous melanomas are "thin" (Breslow thickness ≤1 mm, designated T1 in the American Joint Committee on Cancer staging system) and local recurrence (LR) is rare. Most current management guidelines recommend 1 cm surgical excision margins for T1 melanomas, but evidence to support this recommendation is sparse. We sought to identify clinical and pathologic factors associated with LR in patients with T1 melanomas that might guide primary tumor management. METHODS: From a large, prospectively collected, single-institution database, patients with primary cutaneous melanomas ≤1 mm thick diagnosed between 1970 and 2011 who developed LR were identified and matched with controls. Clinical and pathologic parameters were analyzed for their association with LR. RESULTS: From 11,290 primary melanomas ≤1 mm thick, 176 (1.56 %) cases with LR were identified and 176 controls (without LR) were selected. LR occurred after a median time of 37 months (range 3-306 months) and was associated with narrower excision margins (hazard ratio = 0.95, 95 % confidence interval 0.92-0.98, p = 0.001), desmoplastic, acral, and lentigo maligna melanoma subtypes (p = 0.008), and melanomas composed predominantly of spindle cells (p = 0.005). However, Breslow thickness, Clark level, ulceration, mitotic rate, regression, and lymphovascular invasion were not. CONCLUSIONS: LR was associated with <8 mm histologic excision margins (corresponding to <1 cm margins in vivo) and desmoplastic, acral, and lentigo maligna melanoma subtypes. This study provides evidence that a ≥1 cm clinical excision margin for thin (T1) primary melanomas reduces the risk of LR.
BACKGROUND: At presentation, most primary cutaneous melanomas are "thin" (Breslow thickness ≤1 mm, designated T1 in the American Joint Committee on Cancer staging system) and local recurrence (LR) is rare. Most current management guidelines recommend 1 cm surgical excision margins for T1 melanomas, but evidence to support this recommendation is sparse. We sought to identify clinical and pathologic factors associated with LR in patients with T1 melanomas that might guide primary tumor management. METHODS: From a large, prospectively collected, single-institution database, patients with primary cutaneous melanomas ≤1 mm thick diagnosed between 1970 and 2011 who developed LR were identified and matched with controls. Clinical and pathologic parameters were analyzed for their association with LR. RESULTS: From 11,290 primary melanomas ≤1 mm thick, 176 (1.56 %) cases with LR were identified and 176 controls (without LR) were selected. LR occurred after a median time of 37 months (range 3-306 months) and was associated with narrower excision margins (hazard ratio = 0.95, 95 % confidence interval 0.92-0.98, p = 0.001), desmoplastic, acral, and lentigo maligna melanoma subtypes (p = 0.008), and melanomas composed predominantly of spindle cells (p = 0.005). However, Breslow thickness, Clark level, ulceration, mitotic rate, regression, and lymphovascular invasion were not. CONCLUSIONS: LR was associated with <8 mm histologic excision margins (corresponding to <1 cm margins in vivo) and desmoplastic, acral, and lentigo maligna melanoma subtypes. This study provides evidence that a ≥1 cm clinical excision margin for thin (T1) primary melanomas reduces the risk of LR.
Authors: Alexander H R Varey; Chris Goumas; Angela M Hong; Graham J Mann; Gerald B Fogarty; Jonathan R Stretch; Robyn P M Saw; Andrew J Spillane; Kerwin F Shannon; Kenneth J Lee; Michael J Quinn; John F Thompson; Richard A Scolyer Journal: Mod Pathol Date: 2017-07-21 Impact factor: 7.842
Authors: F C Wright; L H Souter; S Kellett; A Easson; C Murray; J Toye; D McCready; C Nessim; D Ghazarian; N J Look Hong; S Johnson; D P Goldstein; T Petrella Journal: Curr Oncol Date: 2019-08-01 Impact factor: 3.677
Authors: Jeremy Hay; Jeff Keir; Clara Jimenez Balcells; Nikita Rosendahl; Martelle Coetzer-Botha; Tobias Wilson; Simon Clark; Astrid Baade; Cath Becker; Luke Bookallil; Chris Clifopoulos; Tony Dicker; Martin Paul Denby; Douglas Duthie; Charles Elliott; Paul Fishburn; Mark Foley; Mark Franck; Irene Giam; Patricio Gordillo; Alister Lilleyman; Roger Macauley; James Maher; Ewen McPhee; Michael Reid; Bob Shirlaw; Graeme Siggs; Robert Spark; John Stretch; Keith van Den Heever; Thinus van Rensburg; Chris Watson; Harald Kittler; Cliff Rosendahl Journal: Australas J Dermatol Date: 2022-04-19 Impact factor: 2.481
Authors: Licata Gaetano; Birra Domenico; Serigne N Lo; Tasnia Hamed; Alison J Potter; John F Thompson; Richard A Scolyer; Pascale Guitera Journal: JAAD Int Date: 2022-06-16