Randomised trial of width of excision of thick cutaneous malignant melanoma.
Disease site: Melanoma
Treatment modality: Surgery
The UK Melanoma Study Group and the British Association of Plastic Surgeons (MSG/BAPS) multi-centre randomised trial of surgical width of excision margin in patients with thick cutaneous malignant melanoma recruited 900 patients between 1993 and 2001 to determine the optimal margin of excision.
Eligible patients with a single primary histological diagnosis of malignant melanoma 2mm Breslow thickness were randomised to a 1cm or 3cm surgical excision margin. In addition to the UK, patients were recruited from Poland and South Africa and the trial was run in collaboration with the Scottish Cancer Therapy Network.
After a median follow-up of 60 months, MSG-BAPS concluded that a 1cm margin for excision of melanoma is associated with a significantly greater risk of loco-regional recurrence, but that there was little difference in overall survival between the two groups. Pending analysis after longer term follow up, the authors of the publication recommended that patients be given the choice after informed discussions of the surgical options, but that it may be prudent to use a 3cm margin excision in patients with deeper tumours.
Chief Investigator: Mr J. M. Thomas, The Royal Marsden NHS Foundation Trust
ICR-CTSU Scientific Lead: Professor Judith Bliss
Trial management contact: [email protected]
Sponsor: UK Co-ordinating Committee for Cancer Research (UKCCCR)
Funding: North Thames NHS R&D, BUPA Foundation, BAPS.
Publications and presentations
Newton-Bishop JA, Nolan C, Turner F, McCabe M, Boxer C, Thomas JM, Coombes G, A'Hern RP, Barrett JH. A quality-of-life study in high-risk (thickness > = or 2 mm) cutaneous melanoma patients in a randomized trial of 1-cm versus 3-cm surgical excision margins. J. Investig. Dermatol. Symp. Proc. 2004;9(2):152-59
Thomas JM, Newton-Bishop J, A'Hern R, Coombes G, Timmons M, Evans J, Cook M, Theaker J, Fallowfield M, O'Neill T, Ruka W, Bliss JM. Excision margins in high-risk malignant melanoma. N. Engl. J. Med. 2004;350(8):757-66
Thomas JM, Newton-Bishop JA, Timmons M, Evans J, Cook M, Lallemand R, Morgan B, O'Neill T, Hall P, Ruka W, Nowecki, Sklodowska M, Curley G, A'Hern R, Bliss J, Coombes G. Surgical margin excision width in high (minimum depth 2mm) cutaneous malignant melanoma: a randomized trial of 1cm versus 3cm excision margins in 900 patients. J. Clin. Oncol. 2002;20:15S #1358