a retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm：回顾性分析1 - 2cm的切缘皮肤恶性黑色素瘤的厚度大于2毫米.pdfVIP

A retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm Robert E. Hunger, MD, PhD,a Sarina Angermeier, MD,b S. Morteza Seyed Jafari, MD,b Adrian Ochsenbein, MD,c and Maziar Shafighi, MDb Bern, Switzerland Background: Most guidelines recommend at least 2-cm excision margin for melanomas thicker than 2 mm. Objective: We evaluated whether 1- or 2-cm excision margins for melanoma ( [2 mm) result in different outcomes. Methods: This is a retrospective cohort study on patients with melanomas ( [2 mm) who underwent tumor excision with 1-cm (228 patients) or 2-cm (97 patients) margins to investigate presence of local recurrences, locoregional and distant metastases, and disease-free and overall survival. Results: In all, 325 patients with mean age of 61.84 years and Breslow thickness of 4.36 mm were considered for the study with a median follow-up of 1852 days (1995-2012). There was no significant difference in the frequency of locoregional and distant metastasis between the 2 groups (P = .311 and .571). The survival analysis showed no differences for disease-free (P = .800; hazard ratio 0.948; 95% confidence interval 0.627-1.433) and overall (P = .951; hazard ratio 1.018; 95% confidence interval 0.575-1.803) survival. Limitations: The study was not prospectively randomized. Conclusions: Our study did not show any significant differences in important outcome parameters such as local or distant metastases and overall survival. A prospective study testing 1- versus 2-cm excision margin is warranted. ( J Am Acad Dermatol 2015;72:1054-9.) Key words: disease-free survival; margin of excision; melanomas