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Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma

Citation

Sladden, MJ and Nieweg, OE and Howle, J and Coventry, BJ and Thompson, JF, Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma, Medical Journal of Australia, 208, (3) pp. 137-142. ISSN 0025-729X (2018) [Refereed Article]

Copyright Statement

2018 AMPCo Pty Ltd. All rights reserved

DOI: doi:10.5694/mja17.00278

Abstract

Introduction: Definitive management of primary cutaneous melanoma consists of surgical excision of the melanoma with the aim of curing the patient. The melanoma is widely excised together with a safety margin of surrounding skin and subcutaneous tissue, after the diagnosis and Breslow thickness have been established by histological assessment of the initial excision biopsy specimen. Sentinel lymph node biopsy should be discussed for melanomas ≥ 1 mm thickness (≥ 0.8 mm if other high risk features) in which case lymphoscintigraphy must be performed before wider excision of the primary melanoma site. The 2008 evidence‐based clinical practice guidelines for the management of melanoma (http://www.cancer.org.au/content/pdf/HealthProfessionals/ClinicalGuidelines/ClinicalPracticeGuidelines‐ManagementofMelanoma.pdf ) are currently being revised and updated in a staged process by a multidisciplinary working party established by Cancer Council Australia. The guidelines for definitive excision margins for primary melanomas have been revised as part of this process.

Main recommendations: The recommendations for definitive wide local excision of primary cutaneous melanoma are:

  • melanoma in situ: 510 mm margins
  • invasive melanoma (pT1) ≤ 1.0 mm thick: 1 cm margins
  • invasive melanoma (pT2) 1.012.00 mm thick: 12 cm margins
  • invasive melanoma (pT3) 2.014.00 mm thick: 12 cm margins
  • invasive melanoma (pT4) > 4.0 mm thick: 2 cm margins
  • Changes in management as a result of the guideline: Based on currently available evidence, excision margins for invasive melanoma have been left unchanged compared with the 2008 guidelines. However, melanoma in situ should be excised with 510 mm margins, with the aim of achieving complete histological clearance. Minimum clearances from all margins should be assessed and stated. Consideration should be given to further excision if necessary; positive or close histological margins are unacceptable.

    Item Details

    Item Type:Refereed Article
    Keywords:skin and connective tissue disease, surgical procedures, operative, general medicine
    Research Division:Biomedical and Clinical Sciences
    Research Group:Clinical sciences
    Research Field:Dermatology
    Objective Division:Health
    Objective Group:Clinical health
    Objective Field:Clinical health not elsewhere classified
    UTAS Author:Sladden, MJ (Dr Mike Sladden)
    ID Code:133979
    Year Published:2018
    Web of Science® Times Cited:12
    Deposited By:Medicine
    Deposited On:2019-07-18
    Last Modified:2019-08-23
    Downloads:0

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