Table 1.

Melanoma Depth	Margin Recommendation
NCCN ¹ and ESMO ² Guidelines
Melanoma in situ	0.5 cm
< 1 mm	1 cm
1.0–2.0 mm	1–2 cm
> 2 mm	2 cm
Australian Cancer Network Guidelines ³
Melanoma in situ	0.5 cm
< 1 mm	1 cm
1.0–2.0 mm	1–2 cm
2.0–4.0 mm	1–2 cm
> 4.0 mm	2 cm

Current Guidelines for Excision Margins in Primary Cutaneous Melanoma

Abbreviation: ESMO, European Society for Medical Oncology.

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Author(s)

Joyce Y. Wong, MD

Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida

Disclosures

Disclosure: Joyce Y. Wong, MD, has disclosed no relevant financial relationships.

Vernon K. Sondak, MD

Departments of Oncologic Sciences and Surgery, University of South Florida College of Medicine, Tampa, Florida

Disclosures

Disclosure: Vernon K. Sondak, MD, has disclosed no relevant financial relationships.

Editor

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

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Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD

Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine

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Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

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Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

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Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

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Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

CME

Unanswered Questions About Margin Recommendations for Primary Cutaneous Melanoma

Authors: Joyce Y. Wong, MD; Vernon K. Sondak, MD
CME Released: 3/5/2012
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 3/5/2013, 11:59 PM EST

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Target Audience and Goal Statement

This activity is intended for primary care physicians, dermatologists, pathologists, and other physicians who care for patients with melanoma.

The goal of this activity is to evaluate variables that might affect surgical decision-making in cases of melanoma.

Upon completion of this activity, participants will be able to:

Distinguish current recommendations for surgical margins in excision of melanoma
Evaluate different methods for the biopsy of melanoma and the role of expert pathologists
Analyze surgical practices for melanoma
Assess how to manage nevi among patients with melanoma

Disclosures

Author(s)

Joyce Y. Wong, MD

Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida

Disclosures

Disclosure: Joyce Y. Wong, MD, has disclosed no relevant financial relationships.

Vernon K. Sondak, MD

Departments of Oncologic Sciences and Surgery, University of South Florida College of Medicine, Tampa, Florida

Disclosures

Disclosure: Vernon K. Sondak, MD, has disclosed no relevant financial relationships.

Editor

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD

Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

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Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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Abstract and Introduction

Abstract

Radical wide excision with appropriate margins based on depth of tumor invasion has been the standard adopted in NCCN and national clinical practice guidelines in oncology based on randomized controlled trial data. When carefully scrutinized, however, questions remain unanswered about what constitute appropriate margins in many frequently encountered clinical situations. In addition to the single characteristic of tumor depth, factors such as primary tumor location, histologic classification, and even specific patient characteristics may all contribute to risk for local recurrence, and therefore should potentially be considered in margin recommendations. This article addresses current uncertainty surrounding optimal margin status in primary cutaneous melanoma. (JNCCN 2012;10:357–365)

Introduction

Surgical removal remains the mainstay of treatment for primary cutaneous melanoma, and is generally considered one of the most noncontroversial aspects of melanoma management. Because the term wide local excision has no specific meaning nor a corresponding procedural billing code, the authors prefer the term radical wide excision to refer to any surgical procedure for primary melanoma intended to 1) include a minimum measured margin of normal-appearing skin in all radial directions surrounding the melanoma biopsy scar and/or any residual pigmented lesion at that site (wide excision); and 2) extend downward to the level of the investing muscular fascia (radical excision). The current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma (available in this issue and online at www.NCCN.org)^[1] and those of Europe^[2] and of Australia and New Zealand^[3] all recommend 1- to 2-cm excision margins predicated on the Breslow thickness of the primary tumor ( Table 1 ). However, in this era of personalized medicine, it seems evident that factors other than the tumor’s thickness should at least be considered in surgical decision-making.

Page 1 of 4

Unanswered Questions About Excision Margins

CME Information

Abstract and Introduction
Unanswered Questions About Excision Margins
The Impact of Biopsy Techniques and Dermatopathology Review on Excision Margin Recommendations
Conclusions

References

References

Disclaimer

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Published by Harborside Press

Table 1.

References

Faculty and Disclosures

Author(s)

Joyce Y. Wong, MD

Vernon K. Sondak, MD

Editor

Kerrin M. Green, MA

CME Author

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

CME

Unanswered Questions About Margin Recommendations for Primary Cutaneous Melanoma

Target Audience and Goal Statement

Disclosures

Author(s)

Joyce Y. Wong, MD

Vernon K. Sondak, MD

Editor

Kerrin M. Green, MA

CME Author

Charles P. Vega, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Unanswered Questions About Margin Recommendations for Primary Cutaneous Melanoma

Abstract and Introduction

Abstract

Introduction

Table of Contents