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Titolo:
Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas
Autore:
Balch, CM; Soong, S; Smith, T; Ross, MI; Urist, MM; Karakousis, CP; Temple, WJ; Mihm, MC; Barnhill, RL; Jewell, WR; Wanebo, HJ; Desmond, R;
Indirizzi:
Johns Hopkins Med Ctr, Baltimore, MD USA Johns Hopkins Med Ctr Baltimore MD USA opkins Med Ctr, Baltimore, MD USA Univ Alabama, Birmingham, AL USA Univ Alabama Birmingham AL USAUniv Alabama, Birmingham, AL USA Morristown Mem Hosp, Morristown, NJ USA Morristown Mem Hosp Morristown NJUSA stown Mem Hosp, Morristown, NJ USA Univ Texas, MD Anderson Canc Ctr, Houston, TX 77030 USA Univ Texas Houston TX USA 77030 Anderson Canc Ctr, Houston, TX 77030 USA Roswell Pk Canc Inst, Buffalo, NY 14263 USA Roswell Pk Canc Inst Buffalo NY USA 14263 anc Inst, Buffalo, NY 14263 USA Univ Calgary, Calgary, AB, Canada Univ Calgary Calgary AB CanadaUniv Calgary, Calgary, AB, Canada Massachusetts Gen Hosp, Boston, MA 02114 USA Massachusetts Gen Hosp Boston MA USA 02114 Gen Hosp, Boston, MA 02114 USA Univ Kansas, Kansas City, KS USA Univ Kansas Kansas City KS USAUniv Kansas, Kansas City, KS USA Roger Williams Hosp, Providence, RI USA Roger Williams Hosp Providence RIUSA Williams Hosp, Providence, RI USA
Titolo Testata:
ANNALS OF SURGICAL ONCOLOGY
fascicolo: 2, volume: 8, anno: 2001,
pagine: 101 - 108
SICI:
1068-9265(200103)8:2<101:LROAPS>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
CUTANEOUS MALIGNANT-MELANOMA; STAGE-I MELANOMA; PROGNOSTIC FACTORS; LOCAL RECURRENCE; TUMOR THICKNESS; MULTIFACTORIAL ANALYSIS; RESECTION MARGINS; SKIN; EFFICACY; HEAD;
Keywords:
melanoma; surgical excision margins; neoplasm staging; Cox regression; risk factors;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Balch, CM 1900 Duke St,Suite 200, Alexandria, VA 22314 USA 1900 Duke St,Suite 200 Alexandria VA USA 22314 ia, VA 22314 USA
Citazione:
C.M. Balch et al., "Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas", ANN SURG O, 8(2), 2001, pp. 101-108

Abstract

Background: The Intergroup Melanoma Surgical Trial began in 1983 to examine the optimal surgical margins of excision for primary melanomas of intermediate thickness (i.e., 1-4 mm). There is now a median 10-year follow-up. Methods: There were two cohorts entered into a prospective multi-institutional trial: (1) 468 patients with melanomas on the trunk or proximal extremity who randomly received a 2 cm or 4 cm radial excision margin and (2) 272patients with melanomas on the head, neck, or distal extremities who received a 2 cm radial excision margin. Results: A local recurrence (LR) was associated with a high mortality rate, with a 5-year survival rate of only 9% (as a first relapse) or 11% (anytime) compared with an 86% survival for those patients who did trot have a LR(P < .0001). The 10-year survival for all patients with a LR was 5%. The 10-year survival rates were not significantly different when comparing 2 cm vs. 4 cm margins of excision (70% vs. 77%) or comparing the management of the regional lymph nodes (observation vs, elective node dissection). The incidences of LR were the same for patients having a 2 cm vs. 4 cm excision margin regardless of whether the comparisons were made as first relapse (0.4%vs. 0.9%) or at anytime (2.1% vs. 2.6%). When analyzed by anatomic site, the LR rates were 1.1% for melanomas arising on the proximal extremity, 3.1%for the trunk, 5.3% fur the distal extremities, and 9.4%, for the head andneck. The most profound influence on LR rates was the presence or absence of ulceration; it was 6.6% vs. 1.1% in the randomized group involving the trunk and proximal extremity and was 16.2% vs. 2.1% in the nun-randomized group involving the distal extremity and head and neck (P < .001). A multivariate (Cox) regression analysis showed that ulceration was an adverse and independent factor (P = .0001) as was head and neck melanoma site (P = .01), while the remaining factors were not significant (all with P > .12). Conclusion: For this group of melanoma patients, a local recurrence is associated with a high mortality rate, a 2-cm margin of excision is safe and ulceration of the primary melanoma is the most significant prognostic factorheralding an increased risk for a local recurrence.

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Documento generato il 07/04/20 alle ore 22:52:31