Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethics Statement
2.2. Patients
2.3. Surgical Margins
2.4. Statistical Analysis
3. Results
3.1. Patient Data
3.2. Surgical Margins for Invasive Acral Melanomas
3.3. Patient Outcomes at the End of the Follow-Up Periods
3.4. Kaplan-Meier Analysis for MSS and DFS
3.5. Comparison between Narrow and Recommended Margins
3.6. Prognostic Impact of Surgical Margin from Nodule
3.7. Comparison between Narrow and Sufficient Margins from Nodules
3.8. Cox Multivariate Analyses for MSS and DFS: Surgical Margins from Lateral Borders
3.9. Cox Multivariate Analyses for MSS and DFS: Surgical Margins from Nodules
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Parameter | Number (%) |
---|---|
Age in years | |
Range (mean ± SD) | 16–89 (67.0 ± 15.7) |
Sex | |
Male | 42 (42.0) |
Female | 58 (58.0) |
Histopathological subtype | |
Acral lentiginous | 100 (100) |
Primary tumor site | |
Palm | 15 (15.0) |
Sole | 65 (65.0) |
Nail bed | 20 (20.0) |
Ulceration | |
Present | 49 (49.0) |
Absent | 51 (51.0) |
T category | |
T1 | 31 (31.0) |
T2 | 15 (15.0) |
T3 | 16 (16.0) |
T4 | 38 (38.0) |
American Joint Committee on Cancer stage | |
I | 42 (42.0) |
II | 30 (30.0) |
III | 23 (23.0) |
IV | 5 (5.0) |
Melanoma-specific survival in months | |
Range (mean ± SD) | 1–175 (54.3 ± 43.9) |
Disease-free survival in months | |
Range (mean ± SD) | 0–175 (48.4 ± 46.3) |
Total | 100 (100.0) |
T Category (NCCN Recommendation) | Surgical Margin from Tumor Border | Patients (n) | Positive Margin (n) |
---|---|---|---|
T1 | 5 mm | 16 | 1 a |
(10 mm) | ≥10 mm | 15 | 1 b |
T2 | 5 mm | 3 | 0 |
(10–20 mm) | 10 mm | 8 | 1 c |
20 mm | 4 | 0 | |
T3 | 10 mm | 11 | 0 |
(20 mm) | 15 mm | 2 | 0 |
20 mm | 3 | 0 | |
T4 | 5 mm | 7 | 0 |
(20 mm) | 10 mm | 20 | 0 |
15 mm | 6 | 0 | |
≥20 mm | 5 | 0 |
T Category | Surgical Margin (n) | Local Recurrence | In Transit Metastasis | Death Due to Melanoma | Follow-Up (Person-Years) |
---|---|---|---|---|---|
T1 | Narrow (16) | 1 (6.3%) | 0 | 2 (12.5%) | 72.6 |
Recommended (15) | 0 | 0 | 0 | 72.3 | |
T2 | Narrow (3) | 0 | 0 | 0 | 7.3 |
Recommended (12) | 0 | 0 | 1 (8.3%) | 68.6 | |
T3 | Narrow (12) | 0 | 3 (25.0%) | 0 | 67.3 |
Recommended (3) | 0 | 1 (33.1%) | 1 (33.3%) | 15.1 | |
T4 | Narrow (29) | 1 (3.4%) | 4 (13.8%) | 14 (48.3%) | 122.4 |
Recommended (5) | 0 | 0 | 1 (20.0%) | 19.9 |
Parameter | Narrow | Recommended | p |
---|---|---|---|
Age in years | |||
Mean ± SD | 67.3 ± 15.8 | 66.3 ± 16.8 | 0.9220 |
Breslow thickness (mm) | |||
Mean ± SD | 4.21 ± 2.96 | 2.03 ± 2.20 | 0.0013 * |
Sex | |||
Male | 25 | 12 | 0.5194 |
Female | 35 | 23 | |
Primary tumor site | |||
Palm | 9 | 6 | 0.9540 |
Sole | 38 | 22 | |
Nail bed | 13 | 7 | |
Ulceration | |||
Present | 31 | 14 | 0.2947 |
Absent | 29 | 21 | |
American Joint Committee on Cancer stage | |||
I or II | 42 | 30 | 0.1351 |
III | 18 | 5 | |
Total | 60 | 35 |
Parameter | Narrow | Sufficient | p |
---|---|---|---|
Age in years | |||
Mean ± SD | 65.1 ± 16.6 | 68.7 ± 15.5 | 0.2264 |
Breslow thickness (mm) | |||
Mean ± SD | 3.86 ± 3.11 | 2.62 ± 2.55 | 0.0633 |
Sex | |||
Male | 17 | 20 | 0.8336 |
Female | 29 | 29 | |
Primary tumor site | |||
Palm | 9 | 6 | 0.4120 |
Sole | 26 | 34 | |
Nail bed | 11 | 9 | |
Ulceration | |||
Present | 21 | 24 | 0.8379 |
Absent | 25 | 25 | |
American Joint Committee on Cancer stage | |||
I or II | 33 | 39 | 0.4736 |
III | 13 | 10 | |
Total | 46 | 49 |
MSS | DFS | |||||
---|---|---|---|---|---|---|
Variable | HR | 95% CI | p | HR | 95% CI | p |
Age † | 1.05 | 1.01–1.10 | 0.0286 * | 1.03 | 0.99–1.06 | 0.0892 |
Sex, male | 1.87 | 0.75–4.65 | 0.1806 | 1.73 | 0.82–3.66 | 0.1528 |
Breslow thickness † | 1.20 | 1.02–1.40 | 0.0226 * | 1.19 | 1.05–1.34 | 0.0045 * |
Surgical margin, narrow | 1.83 | 0.47–7.14 | 0.3836 | 1.73 | 0.60–4.99 | 0.3092 |
MSS | DFS | |||||
---|---|---|---|---|---|---|
Variable | HR | 95% CI | p | HR | 95% CI | p |
Age † | 1.05 | 1.01–1.10 | 0.0265 * | 1.03 | 0.99–1.06 | 0.0797 |
Sex, male | 1.99 | 0.79–5.03 | 0.1459 | 1.84 | 0.86–3.93 | 0.1169 |
Breslow thickness † | 1.23 | 1.06–1.42 | 0.0045 * | 1.22 | 1.08–1.36 | 0.0006 * |
Margin from nodule, narrow | 1.29 | 0.50–3.33 | 0.5962 | 1.23 | 0.56–2.70 | 0.6087 |
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Ito, T.; Kaku-Ito, Y.; Wada-Ohno, M.; Furue, M. Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable? J. Clin. Med. 2020, 9, 2266. https://doi.org/10.3390/jcm9072266
Ito T, Kaku-Ito Y, Wada-Ohno M, Furue M. Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable? Journal of Clinical Medicine. 2020; 9(7):2266. https://doi.org/10.3390/jcm9072266
Chicago/Turabian StyleIto, Takamichi, Yumiko Kaku-Ito, Maiko Wada-Ohno, and Masutaka Furue. 2020. "Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable?" Journal of Clinical Medicine 9, no. 7: 2266. https://doi.org/10.3390/jcm9072266
APA StyleIto, T., Kaku-Ito, Y., Wada-Ohno, M., & Furue, M. (2020). Narrow-Margin Excision for Invasive Acral Melanoma: Is It Acceptable? Journal of Clinical Medicine, 9(7), 2266. https://doi.org/10.3390/jcm9072266