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

journal contribution
posted on 2023-05-20, 05:40 authored by Michael SladdenMichael Sladden, Nieweg, OE, Howle, J, Coventry, BJ, Thompson, JF

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: 5–10 mm margins
  • invasive melanoma (pT1) ≤ 1.0 mm thick: 1 cm margins
  • invasive melanoma (pT2) 1.01–2.00 mm thick: 1–2 cm margins
  • invasive melanoma (pT3) 2.01–4.00 mm thick: 1–2 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 5–10 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.

    History

    Publication title

    Medical Journal of Australia

    Volume

    208

    Pagination

    137-142

    ISSN

    0025-729X

    Department/School

    Tasmanian School of Medicine

    Publisher

    Australasian Med Publ Co Ltd

    Place of publication

    Level 1, 76 Berry St, Sydney, Australia, Nsw, 2060

    Rights statement

    © 2018 AMPCo Pty Ltd. All rights reserved

    Repository Status

    • Restricted

    Socio-economic Objectives

    Treatment of human diseases and conditions; Clinical health not elsewhere classified

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