LOCAL RECURRENCE IN MALIGNANT-MELANOMA - LONG-TERM RESULTS OF THE MULTIINSTITUTIONAL RANDOMIZED SURGICAL TRIAL

Background: In the past, radical margins of excision were prescribed f or cutaneous melanoma based on preconceived notions rather than on har d clinical evidence. Methods: In a prospective study of 742 patients w ith intermediate-thickness melanoma (1-4 mm), 470 patients with trunk or proximal extremity lesions were randomized into a 2- or 4-cm margin . Patients with distal extremity or head and neck lesions (n = 272) re ceived uniformly a 2-cm margin. Results: The overall rate of local rec urrence was 3.8%. This rate in the randomized portion (n = 470) was 2. 1% for the 2-cm margin and 2.6% for the 4-cm margin (p = 0.72), A prog ressive increase in focal recurrence rates was observed with thickness : 2.3% for lesions 1.0-2.0 mm, 4.2% for those 2.01-3.0 mm, and 11.7% f or those 3.01-4.0 mm thick (p = 0.001). Local recurrence occurred in 1 .5% of those without ulceration and in 10.6% of those with ulceration of the primary lesion (p = 0.001), The local recurrence rate was wt si gnificantly affected by the margin of resection even among the thicker or ulcerated lesions. It also was not affected significantly by the m ethod of closure of the primary site or management of the regional nod es, or the age or gender of the patients. Conclusions: A 2-cm margin i s as effective as a 4-cm margin in local control and survival of inter mediate-thickness melanomas. The local recurrence rate is significantl y affected by the thickness of the primary lesion and the presence or not of ulceration.