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Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?

In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with...

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Autores principales: Ito, Takamichi, Kaku-Ito, Yumiko, Wada-Ohno, Maiko, Furue, Masutaka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408916/
https://www.ncbi.nlm.nih.gov/pubmed/32708762
http://dx.doi.org/10.3390/jcm9072266
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author Ito, Takamichi
Kaku-Ito, Yumiko
Wada-Ohno, Maiko
Furue, Masutaka
author_facet Ito, Takamichi
Kaku-Ito, Yumiko
Wada-Ohno, Maiko
Furue, Masutaka
author_sort Ito, Takamichi
collection PubMed
description In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with narrow margins (N-group). A total of 65 patients underwent narrow-margin excision. Positive margin status or local recurrence rarely occurred regardless of the excision margins, whereas fatal events frequently occurred, particularly among the patients with T4 melanoma. The mortality rates of N- and R-group with T1–3 melanomas were similar (1.36 and 1.28 per 100 person-years, respectively). However, patients with T4 melanoma treated with narrow-margin excision had a higher mortality rate (11.44 vs. 5.03 per 100 person-years). Kaplan–Meier analyses showed a worse prognosis in the N-group (p = 0.045) but this group had thicker Breslow thickness (4.21 mm vs. 2.03 mm, p = 0.0013). A multivariate analysis showed that Breslow thickness was an independent risk factor, but surgical margin was not a risk factor for melanoma-specific survival or disease-free survival. In conclusion, although we could not find a difference between the narrow-margin excision and recommended-margin excision in this study, we suggest following current recommendations of guidelines. Our study warrants the prospective collection of data on acral melanoma to better define the prognosis of this infrequent type of melanoma.
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spelling pubmed-74089162020-08-13 Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable? Ito, Takamichi Kaku-Ito, Yumiko Wada-Ohno, Maiko Furue, Masutaka J Clin Med Article In this retrospective review of 100 patients with primary invasive acral melanoma, we examined whether narrow-margin excision is warranted for acral melanoma. Patients treated with surgical margins recommended by the National Comprehensive Cancer Network (R-group) were compared to those treated with narrow margins (N-group). A total of 65 patients underwent narrow-margin excision. Positive margin status or local recurrence rarely occurred regardless of the excision margins, whereas fatal events frequently occurred, particularly among the patients with T4 melanoma. The mortality rates of N- and R-group with T1–3 melanomas were similar (1.36 and 1.28 per 100 person-years, respectively). However, patients with T4 melanoma treated with narrow-margin excision had a higher mortality rate (11.44 vs. 5.03 per 100 person-years). Kaplan–Meier analyses showed a worse prognosis in the N-group (p = 0.045) but this group had thicker Breslow thickness (4.21 mm vs. 2.03 mm, p = 0.0013). A multivariate analysis showed that Breslow thickness was an independent risk factor, but surgical margin was not a risk factor for melanoma-specific survival or disease-free survival. In conclusion, although we could not find a difference between the narrow-margin excision and recommended-margin excision in this study, we suggest following current recommendations of guidelines. Our study warrants the prospective collection of data on acral melanoma to better define the prognosis of this infrequent type of melanoma. MDPI 2020-07-16 /pmc/articles/PMC7408916/ /pubmed/32708762 http://dx.doi.org/10.3390/jcm9072266 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ito, Takamichi
Kaku-Ito, Yumiko
Wada-Ohno, Maiko
Furue, Masutaka
Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
title Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
title_full Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
title_fullStr Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
title_full_unstemmed Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
title_short Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
title_sort narrow-margin excision for invasive acral melanoma: is it acceptable?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408916/
https://www.ncbi.nlm.nih.gov/pubmed/32708762
http://dx.doi.org/10.3390/jcm9072266
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