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Excision Margins in the Treatment of Primary Cutaneous Melanoma
A Systematic Review of Randomized Controlled Trials Comparing Narrow vs Wide Excision
Marko B. Lens, MD;
Martin Dawes, MD;
Tim Goodacre, MD;
Julia A. Newton Bishop, MD
Arch Surg. 2002;137:1101-1105.
Background The optimal excision margin for primary cutaneous melanoma remains controversial, although several clinical studies have suggested that wide local excision is unnecessary.
Hypothesis Wide excision margins do not improve survival in patients with melanoma.
Objectives To describe the published evidence and determine the effectiveness of wide surgical margins compared with narrow surgical margins.
Design Systematic review of randomized controlled trials that compared narrow margins with wide excision margins for cutaneous melanoma.
Setting Randomized controlled trials available by March 2001.
Subjects The included trials comprised 2406 participants.
Intervention Surgical excision of melanoma using narrow excision margins compared with excision using wide excision margins.
Main Outcome Measure Effect of width of excision margin on melanoma recurrences, disease-free survival, and overall survival.
Results We identified and analyzed 4 randomized controlled trials. All 4 trials failed to demonstrate statistically significant differences in overall survival and disease-free survival when comparing wide vs narrow excision. Peto pooled odds ratio for overall survival was 0.79 (95% confidence interval, 0.61-1.04) and for disease-free survival was 0.89 (95% confidence interval, 0.69-1.13), indicating a statistically nonsignificant improvement with wide excision.
Conclusions Not one of the included studies showed any statistically significant difference between the 2 groups treated with narrow or wide excision margins with regard to recurrences and survival. However, current evidence is not sufficient to address the optimal surgical margins for all melanomas, and further research is required.
From the Centre for Evidence-Based Medicine, University of Oxford, Nuffield Department of Clinical Medicine, The Oxford Radcliffe National Health Service Trust, Oxford, England (Drs Lens, Dawes, and Goodacre); and Genetic Epidemiology Division, Imperial Cancer Research Fund Clinical Centre, St James's University Hospital, Leeds, England (Dr Bishop).
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