Excision margins in the treatment of primary cutaneous melanoma - A systematic review of randomized controlled trials comparing narrow vs wide excision

Background: The optimal excision margin for primary cutaneous melanoma remains controversial, although several clinical studies have suggested that wide local excision is unnecessary. Hypothesis: Wide excision margins do not improve survival in patients with melanoma. Objectives: To describe the published evidence and determine the effectiveness of wide surgical margins compared with narrow surgical margins. Design: Systematic review of randomized controlled trials that compared narrow margins with wide excision mar gins for cutaneous melanoma. Setting: Randomized controlled trials available by March 2001. Subjects: The included trials comprised 2406 participants. Intervention: Surgical excision of melanoma using narrow excision margins compared with excision using wide excision margins. Main Outcome Measure: Effect of width of excision margin on melanoma recurrences, disease-free survival, and overall survival. Results: We identified and analyzed 4 randomized controlled trials. All 4 trials failed to demonstrate statistically significant differences in overall survival and disease-free survival when comparing wide vs narrow excision. Peto pooled odds ratio for overall survival was 0.79 (95% confidence interval, 0.61-1.04) and for disease-free survival was 0.89 (95% confidence interval, 0.69-1.13), indicating a statistically nonsignificant improvement with wide excision. Conclusions: Not one of the included studies showed any statistically significant difference between the 2 groups treated with narrow or wide excision margins with regard to recurrences and survival. However, current evidence is not sufficient to address the optimal surgical margins for all melanomas, and further research is required.