1 versus 2-cm excision margins for pT2-pT4 primary cutaneous melanoma (MelMarT): A feasibility study

Moncrieff, Marc D., Gyorki, David, Saw, Robyn, Spillane, Andrew J., Peach, Howard, Oudit, Deemesh, Geh, Jenny, Dziewulski, Peter, Wilson, Ewan, Matteucci, Paolo, Pritchard-Jones, Rowan, Bagge, Roger Olofsson, Wright, Frances C., Crampton, Nic, Cassell, Oliver, Jallali, Navid, Berger, Adam, Kelly, John, Hamilton, Stephen, Durrani, Amer, Lo, Serigne, Paton, Elizabeth and Henderson, Michael A. (2018) 1 versus 2-cm excision margins for pT2-pT4 primary cutaneous melanoma (MelMarT): A feasibility study. Annals of Surgical Oncology, 25 (9). 2541–2549. ISSN 1068-9265

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Abstract

Background: There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. Methods: This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. Results: Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p < 0.0001). There was an increased wound necrosis rate in the 2-cm arm (0.5 vs. 3.6%; p = 0.036). After 12 months’ follow-up, no differences were noted in QoL between groups. Discussion: This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Pure Connector
Date Deposited:	01 Jun 2018 13:30
Last Modified:	03 Jul 2023 08:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/67265
DOI:	10.1245/s10434-018-6470-1

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