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Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study

Although the National Comprehensive Cancer Network (NCCN) guidelines include clear recommendations for the appropriate resection margins in non-acral cutaneous melanoma, the required margin for acral melanoma is controversial. In this retrospective study, we aimed to investigate whether narrow-margi...

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Autores principales: Sun, Wei, Xu, Yu, Qu, XingLong, Jin, YongJia, Wang, ChunMeng, Yan, WangJun, Chen, Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10462526/
https://www.ncbi.nlm.nih.gov/pubmed/36988664
http://dx.doi.org/10.1007/s00403-023-02609-2
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author Sun, Wei
Xu, Yu
Qu, XingLong
Jin, YongJia
Wang, ChunMeng
Yan, WangJun
Chen, Yong
author_facet Sun, Wei
Xu, Yu
Qu, XingLong
Jin, YongJia
Wang, ChunMeng
Yan, WangJun
Chen, Yong
author_sort Sun, Wei
collection PubMed
description Although the National Comprehensive Cancer Network (NCCN) guidelines include clear recommendations for the appropriate resection margins in non-acral cutaneous melanoma, the required margin for acral melanoma is controversial. In this retrospective study, we aimed to investigate whether narrow-margin excision is warranted for thick acral melanoma. Records from 277 melanoma patients with stage T3–T4 disease who underwent radical surgery in three centers in China from September 2010 to October 2018 were reviewed. Clinicopathologic data, including age, gender, excision margin (1–2 cm versus ≥ 2 cm), Clark level, Breslow thickness, ulceration, N stage and adjuvant therapy, were included for survival analysis. The patients were followed up until death or March 31, 2021. Log-rank and Cox regression analyses were used to identify prognostic factors for overall survival (OS), disease-free survival (DFS) and local and in-transit recurrence-free survival (LITRFS). Among all enrolled patients, 207 (74.7%) had acral melanoma, and 70 (25.3%) had non-acral cutaneous melanoma. No significant difference in baseline characteristics was identified between non-acral and acral melanoma, except for age (p = 0.004), gender (p = 0.009) and ulceration (p = 0.048). In non-acral melanoma, a resection margin of 1–2 cm was a poor independent prognostic factor for OS [p = 0.015; hazard ratio (HR) (95% CI), 0.26 (0.009–0.77)] and LITRFS [p = 0.013; HR (95% CI), 0.19 (0.05–0.71)] but not for DFS [p = 0.143; HR (95% CI), 0.51 (0.21–1.25)]. Forty-three (20.8%) patients in the acral melanoma group had a 1–2-cm resection margin. The resection margin was not correlated with patients’ OS (p = 0.196 by log-rank analysis, p = 0.865 by multivariate survival analysis), DFS (p = 0.080 by log-rank analysis, p = 0.758 by multivariate survival analysis) or LITRFS (p = 0.354 by log-rank analysis) in acral melanoma. As recommended in the NCCN guidelines, a resection margin ≥ 2 cm is required for non-acral cutaneous melanoma. Meanwhile, a narrow resection margin (1–2 cm) may be safe for patients with acral melanoma.
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spelling pubmed-104625262023-08-30 Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study Sun, Wei Xu, Yu Qu, XingLong Jin, YongJia Wang, ChunMeng Yan, WangJun Chen, Yong Arch Dermatol Res Original Paper Although the National Comprehensive Cancer Network (NCCN) guidelines include clear recommendations for the appropriate resection margins in non-acral cutaneous melanoma, the required margin for acral melanoma is controversial. In this retrospective study, we aimed to investigate whether narrow-margin excision is warranted for thick acral melanoma. Records from 277 melanoma patients with stage T3–T4 disease who underwent radical surgery in three centers in China from September 2010 to October 2018 were reviewed. Clinicopathologic data, including age, gender, excision margin (1–2 cm versus ≥ 2 cm), Clark level, Breslow thickness, ulceration, N stage and adjuvant therapy, were included for survival analysis. The patients were followed up until death or March 31, 2021. Log-rank and Cox regression analyses were used to identify prognostic factors for overall survival (OS), disease-free survival (DFS) and local and in-transit recurrence-free survival (LITRFS). Among all enrolled patients, 207 (74.7%) had acral melanoma, and 70 (25.3%) had non-acral cutaneous melanoma. No significant difference in baseline characteristics was identified between non-acral and acral melanoma, except for age (p = 0.004), gender (p = 0.009) and ulceration (p = 0.048). In non-acral melanoma, a resection margin of 1–2 cm was a poor independent prognostic factor for OS [p = 0.015; hazard ratio (HR) (95% CI), 0.26 (0.009–0.77)] and LITRFS [p = 0.013; HR (95% CI), 0.19 (0.05–0.71)] but not for DFS [p = 0.143; HR (95% CI), 0.51 (0.21–1.25)]. Forty-three (20.8%) patients in the acral melanoma group had a 1–2-cm resection margin. The resection margin was not correlated with patients’ OS (p = 0.196 by log-rank analysis, p = 0.865 by multivariate survival analysis), DFS (p = 0.080 by log-rank analysis, p = 0.758 by multivariate survival analysis) or LITRFS (p = 0.354 by log-rank analysis) in acral melanoma. As recommended in the NCCN guidelines, a resection margin ≥ 2 cm is required for non-acral cutaneous melanoma. Meanwhile, a narrow resection margin (1–2 cm) may be safe for patients with acral melanoma. Springer Berlin Heidelberg 2023-03-29 2023 /pmc/articles/PMC10462526/ /pubmed/36988664 http://dx.doi.org/10.1007/s00403-023-02609-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Paper
Sun, Wei
Xu, Yu
Qu, XingLong
Jin, YongJia
Wang, ChunMeng
Yan, WangJun
Chen, Yong
Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study
title Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study
title_full Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study
title_fullStr Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study
title_full_unstemmed Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study
title_short Surgical resection margin for T3–T4 primary acral melanoma: a multicenter retrospective cohort study
title_sort surgical resection margin for t3–t4 primary acral melanoma: a multicenter retrospective cohort study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10462526/
https://www.ncbi.nlm.nih.gov/pubmed/36988664
http://dx.doi.org/10.1007/s00403-023-02609-2
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