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Revising the Practice of Melanoma Margin Resections-Reply

Michael Piepkorn, MD
[+] Author Affiliations

Dermatology Division University of Washington Box 356524 Seattle, WA 98195-652


Arch Dermatol. 1997;133(1):104-105. doi:10.1001/archderm.1997.03890370116022
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Weinstock takes exception to the conclusion advanced by Barnhill and myself that the choice of a resection margin greater than 1 cm for primary melanomas of any thickness has no factual basis. He bases his objection principally on the data of the randomized, prospective World Health Organization study1,2 of wide (3-cm) vs narrow (1-cm) resection margins, wherein the application of a 1-cm margin for melanomas of 1 mm to 2 mm in thickness was associated with 4 cases of local recurrence (Table).

On statistical analysis, these instances, as compared with no local recurrences in the subset of patients with 3-cm resection margins, approached the threshold of significance, but there was notably no corresponding trend to a difference in survival outcomes between the 2 arms of the study. To Weinstock, however, these data are nevertheless suggestive that the wider margin offers a protective effect against the hazard of local recurrence.

REFERENCES

Veronesi U, Cascinelli N, Adamus J, et al.  Thin stage I primary cutaneous malignant melanoma . N Engl J Med. 1988;;318:1159-1162.
Veronesi U, Cascinelli N.  Narrow excision (1-cm margin) . Arch Surg. 1991;; 126:438-441.
Balch CM, Urist MM, Karakousis CP, et al.  Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm) . Ann Surg. 1993;;218:262-269.
Ringborg U, Andersson R, Eldh J, et al.  Resection margins of 2 versus 5 cm for cutaneous malignant melanoma with a tumor thickness of 0.8 to 2.0 mm: a randomized study by the Swedish Melanoma Study Group . Cancer . 1996;; 77:1809-1814.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Veronesi U, Cascinelli N, Adamus J, et al.  Thin stage I primary cutaneous malignant melanoma . N Engl J Med. 1988;;318:1159-1162.
Veronesi U, Cascinelli N.  Narrow excision (1-cm margin) . Arch Surg. 1991;; 126:438-441.
Balch CM, Urist MM, Karakousis CP, et al.  Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm) . Ann Surg. 1993;;218:262-269.
Ringborg U, Andersson R, Eldh J, et al.  Resection margins of 2 versus 5 cm for cutaneous malignant melanoma with a tumor thickness of 0.8 to 2.0 mm: a randomized study by the Swedish Melanoma Study Group . Cancer . 1996;; 77:1809-1814.

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