Primary excision margins and sentinel lymph node biopsy in clinically node-negative melanoma of the trunk or extremities

Abstract

Aims: For patients with early-stage melanoma, uncertainty exists regarding optimal surgical excision margins of the primary tumour and surgical management of the clinically node-negative lymph node basin. We describe the process of creating a provincial guideline for the treatment of node-negative melanoma of the trunk and extremities. The following research questions were addressed: What are the optimal excision margins for clinically node-negative cutaneous melanoma and should these patients undergo sentinel lymph node biopsy?

Materials and methods: Outcomes were local and regional recurrence, overall and disease-free survival, and morbidity. The MEDLINE and EMBASE databases, National Guideline Clearinghouse, CMA Infobase and websites of guideline development organisations were systematically searched. Using the AGREE instrument, relevant guidelines were assessed and an updated literature search completed. A systematic review and practice guideline was written, reviewed and approved by the Melanoma Site Group and the Program in Evidence-based Care Report Approval Panel. External review by three melanoma experts was completed, as was an online consultation with healthcare professionals who were intended users of the guideline.

Results: One guideline was selected for adoption: the Australian Cancer Network National Health and Medical Research Council and the New Zealand Guidelines group 2008 melanoma guideline. An updated literature search was undertaken to include relevant studies published since the adopted guideline was completed.

Conclusions: Excision margins range from 5mm to 2cm depending on the melanoma depth. Patients with a melanoma greater than 1.0mm in thickness should be given the opportunity to discuss sentinel lymph node biopsy to provide staging and prognostic information.