R. Yeh1, 2, 3, T. M. Hughes1, 2, 3
Introduction: Melanoma has particular importance in Australia due to its high incidence. Despite National Guidelines, a low concordance rate persists in clinical practice. Wider margins and complex wound closure have been associated with increased patient morbidity and higher costs, conveying significant health and economic implications.
Purpose: The aim of our study was to perform a systematic review of the outcomes associated with narrower versus wider margins of excision for primary cutaneous melanoma, in terms of local recurrence, treatment related morbidity and costs. We also aimed to identify various elements of practice that may impact on outcomes and the level of evidence available to support decision making.
Methods: A systematic literature review was conducted across Ovid, PubMed and Medline for trials comparing narrower versus wider margins of excision for melanoma.
Results: A total of 6 randomised controlled trials were identified. Compared with narrower margins, wider margins did not deliver improved recurrence and overall survival rates, but contributed to increased patient morbidity, hospital stay and costs.
Conclusion: Excessive margins of excision result in more extensive surgery with greater morbidity and cost to both individuals and community, without producing better oncologic outcomes. Clinicians must carefully consider the surgical management of every case and consider a conservative approach wherever possible.