Title: Tumor thickness as a guide to surgical management of clinical stage I melanoma patients
Abstract: CancerVolume 43, Issue 3 p. 883-888 ArticleFree Access Tumor thickness as a guide to surgical management of clinical stage I melanoma patients Charles M. Balch MD, Corresponding Author Charles M. Balch MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaDepartment of Surgery, 750 Lyons-Harrison Research Bldg., University of Alabama Medical Center, Birmingham, AL 35294===Search for more papers by this authorTariq M. Murad MD, Tariq M. Murad MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorSeng-Jaw Soong PHD, Seng-Jaw Soong PHD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorAnna Lee Ingalls RN, Anna Lee Ingalls RN University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorPeter C. Richards MD, Peter C. Richards MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorWilliam A. Maddox MD, William A. Maddox MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this author Charles M. Balch MD, Corresponding Author Charles M. Balch MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaDepartment of Surgery, 750 Lyons-Harrison Research Bldg., University of Alabama Medical Center, Birmingham, AL 35294===Search for more papers by this authorTariq M. Murad MD, Tariq M. Murad MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorSeng-Jaw Soong PHD, Seng-Jaw Soong PHD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorAnna Lee Ingalls RN, Anna Lee Ingalls RN University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorPeter C. Richards MD, Peter C. Richards MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this authorWilliam A. Maddox MD, William A. Maddox MD University of Alabama Medical Center Departments of Surgery, Pathology and Biostatistics and the Comprehensive Cancer Center, University of Alabama Medical Center, Birmingham, AlabamaSearch for more papers by this author First published: March 1979 https://doi.org/10.1002/1097-0142(197903)43:3<883::AID-CNCR2820430316>3.0.CO;2-VCitations: 300AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract An analysis of failure to control locally recurrent or metastatic melanoma was used to substantiate the value of thickness as a guide to surgical management. There were no local recurrences in patients with melanomas less than 0.76 mm in thickness, regardless of the skin margins excised. The three year actuarial incidence of subsequent regional metastases in patients initially treated by wide local excision (WLE) of their melanoma was directly correlated with tumor thickness (p = <0.001); it was 0% for lesions <0.76 mm, 25% for 0.76 to 1.50 mm lesions, 51% for 1.50 to 3.99 mm lesions and 62% for lesions >4.0 mm in thickness. At five years, patients with melanomas of 1.50 to 3.99 mm thickness who had WLE plus elective regional node dissection (RND) had a calculated 15% incidence of distant metastases and an actuarial survival rate of 83%, while patients with melanomas of the same thickness who had WLE alone as their initial surgical treatment had a 78% incidence of distant metastases and a 37% survival rate (p = 0.001 and 0.01, respectively). In patients with melanomas exceeding 4.0 mm in thickness, the potential benefits of RND were less apparent because of a high risk (>70%) of distant metastases at the time of initial diagnosis. Based upon this analysis, our initial surgical management of melanomas <0.76 is a WLE using a 2.0 cm margin of skin, while thicker lesions are excised using a 3 to 5 cm skin margin. Elective RND is not indicated for lesion <0.76 mm in thickness, but it is considered for 0.76 to 1.50 mm lesions in selected patients and is employed for virtually all patients with lesions exceeding 1.5 mm in thickness. The rationale of elective RND is improved survival in patients with intermediate thickness lesions (0.76 to 3.99 mm) while it is justifiable as a staging procedure for lesions exceeding 4.0 mm thickness. Cancer 43:883–888, 1979. References 1 Allen, A. C., and Spitz, S.: Malignant melanomas. A clinicopathological analysis of the criteria for diagnosis and prognosis. Cancer 6: 1, 1953. 10.1002/1097-0142(195301)6:1<1::AID-CNCR2820060102>3.0.CO;2-C Web of Science®Google Scholar 2 Balch, C. M., Murad, T. M., Soong, S., Ingalls, A. L., Halpern, N. B., and Maddox, W. A.: A multifactorial analysis of melanoma: I. Prognostic histopathological features comparing Clark's and Breslow's staging methods. Ann. 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