1
|
Maurichi A, Barretta F, Patuzzo R, Miceli R, Gallino G, Mattavelli I, Leva A, Harwood C, Bergamaschi D, Borg TM, Shimonovitz-Moore M, Spadola G, Tolomio E, Barbieri C, Queirolo P, Manganoni AM, Pellacani G, Espeli V, Mangas C, Leoni-Parvex S, Cossa M, Belotti A, Valeri B, Cortinovis U, Santinami M. Similar Local Recurrence and Survival in Patients with T1 Radial Growth Phase Melanoma on Head and Neck Treated with 5 mm or 10 mm Margins. A Retrospective Study. J Eur Acad Dermatol Venereol 2023. [PMID: 36924058 DOI: 10.1111/jdv.19051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Melanoma guidelines recommend surgical excision with 10 mm margins for T1 melanomas (invasive melanomas with Breslow thickness ≤1 mm), including those in radial growth phase, which are without metastatic potential; however, such margins may be problematic on head-and-neck. OBJECTIVE We compared outcomes of wide (10 mm margins) versus narrow (5 mm margins) excisions in patients with radial growth phase T1 melanoma on head-and-neck including face. METHODS We retrospectively examined 610 consecutive patients excised with wide versus narrow margins, from 2001 to 2018, at six European centres. In all cases, radial growth phase, and clear margins with 5 or 10 mm of clearance, were ascertained histologically. Multivariable models investigated associations of margins and other factors with overall survival and local recurrence. RESULTS Three hundred and sixteen (51.8%) patients received wide excision, 219 (69.3%) with primary wound closure, 97 (30.7%) with reconstruction; 294 (48.2%) patients received narrow excision, 264 (89.8%) with primary wound closure, 30 (10.2%) with reconstruction (p<0.001). Median follow-ups were 88 months (wide) and 187 months (narrow) (inter-quartile ranges 43-133 and 79-206, respectively). Ten-year overall survival (95% confidence interval) was 96.7% (94.2-99.3%) in wide and 98.2% (96.4-100%) in narrow patients. Ten-year local recurrence incidence was 6.4% (4.1-10.1%) in wide and 7.8% (5.3-11.6%) in narrow groups. Lentigo maligna melanoma subtype appeared associated with increased risk of local recurrence in narrow versus wide patients (15.0% versus 7.5%; P=0.190). CONCLUSIONS Narrower excision margins for T1 radial growth phase melanoma are not associated with worse overall survival (hazard ratio 0.97, P=0.996) or increased local recurrence (subdistribution hazard ratio: 0.87; P=0.751) compared to wider margins, and may be safely applied to such lesions, although caution may be required in the presence of lentigo maligna melanoma.
Collapse
Affiliation(s)
- Andrea Maurichi
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesco Barretta
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberto Patuzzo
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosalba Miceli
- Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gianfranco Gallino
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Mattavelli
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Andrea Leva
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | - Michal Shimonovitz-Moore
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Giuseppe Spadola
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Elena Tolomio
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Consuelo Barbieri
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Paola Queirolo
- IRCCS Ospedale Policlinico San Martino, Skin Cancer Unit, Genoa, Italy.,European Institute of Oncology, Milan, Italy
| | | | - Giovanni Pellacani
- Department of Dermatology, University of Modena e Reggio Emilia, Italy.,Dermatology Clinic, Department of Internal Anesthesiological and Cardiovascular Clinical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittoria Espeli
- Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Cristina Mangas
- Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Sandra Leoni-Parvex
- Department of Pathology, Istituto Cantonale di Patologia, Locarno, Switzerland
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alessia Belotti
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Department of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| |
Collapse
|