Comparing 2 cm vs. 1 cm surgical margins in acral melanoma of the sole with Breslow thickness greater than 2 mm: A multicenter retrospective study of 336 Japanese patients

Abstract

Introduction: Multiple randomized trials comparing wide local excision (WLE) with different peripheral margins have established recommended peripheral margins according to Breslow thickness (BT) in the National Comprehensive Cancer Network (NCCN) Guidelines. However, these clinical trials included only a small number of patients with acral melanoma (AM). Therefore, we aimed to compare the prognosis of different WLE peripheral margin cohorts with invasive sole AM.

Materials and methods: We conducted a multi-institutional retrospective study of patients with sole AM and a BT greater than 2 mm. Survival outcomes were compared between two groups: those excised with a peripheral margin of 2 cm, as recommended by the NCCN Guidelines, and those excised with a peripheral margin of 1 cm.

Results: This study included 336 patients (2 cm margin: n = 226; 1 cm margin, n = 110) with a median follow-up period of 43.1 months. In multivariate analyses, a peripheral margin of 1 cm did not negatively affect survival (local recurrence-free survival [LRFS]: hazard ratio [HR] 1.19, P = 0.38; disease-free survival [DFS]: HR 1.05, P = 0.75). Survival after propensity score matching showed no significant differences between the matched groups (each group: n = 103; 5-year LRFS: 70.6 % vs. 59.3 %, P = 0.13; 5-year DFS: 47.4 % vs. 54.0 %, P = 0.63).

Conclusion: A peripheral margin of 1 cm did not negatively influence the prognosis of patients with a sole AM and a BT greater than 2 mm. Narrower surgical margins may be acceptable to minimize morbidity without compromising survival.

Keywords: Breslow thickness; Cutaneous melanoma; Surgical margin; Wide local excision; acral melanoma.