1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study
AuthorMoncrieff, MD; Gyorki, D; Saw, R; Spillane, AJ; Peach, H; Oudit, D; Geh, J; Dziewulski, P; Wilson, E; Matteucci, P; ...
Source TitleAnnals of Surgical Oncology
AffiliationSurgery (St Vincent's)
Document TypeJournal Article
CitationsMoncrieff, M. D., Gyorki, D., Saw, R., Spillane, A. J., Peach, H., Oudit, D., Geh, J., Dziewulski, P., Wilson, E., Matteucci, P., Pritchard-Jones, R., Bagge, R. O., Wright, F. C., Crampton, N., Cassell, O., Jallali, N., Berger, A., Kelly, J., Hamilton, S. ,... Henderson, M. A. (2018). 1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study. ANNALS OF SURGICAL ONCOLOGY, 25 (9), pp.2541-2549. https://doi.org/10.1245/s10434-018-6470-1.
Access StatusOpen Access
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.
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