1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT)

A Feasibility Study

Marc D. Moncrieff, David Gyorki, Robyn Saw, Andrew J. Spillane, Howard Peach, Deemesh Oudit, Jenny Geh, Peter Dziewulski, Ewan Wilson, Paolo Matteucci, Rowan Pritchard-Jones, Roger Olofsson Bagge, Frances C. Wright, Nic Crampton, Oliver Cassell, Navid Jallali, Adam Berger, John Kelly, Stephen Hamilton, Amer Durrani & 3 others Serigne Lo, Elizabeth Paton, Michael A. Henderson

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. Methods: This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. Results: Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p < 0.0001). There was an increased wound necrosis rate in the 2-cm arm (0.5 vs. 3.6%; p = 0.036). After 12 months’ follow-up, no differences were noted in QoL between groups. Discussion: This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.

Original languageEnglish (US)
Pages (from-to)2541-2549
Number of pages9
JournalAnnals of surgical oncology
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

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Feasibility Studies
Melanoma
Skin
Quality of Life
Wound Closure Techniques
Sentinel Lymph Node Biopsy
Random Allocation
Margins of Excision
New Zealand
Multicenter Studies
Arm
Necrosis
Neck
Extremities
Head
Morbidity
Costs and Cost Analysis
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Moncrieff, M. D., Gyorki, D., Saw, R., Spillane, A. J., Peach, H., Oudit, D., ... Henderson, M. A. (2018). 1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study. Annals of surgical oncology, 25(9), 2541-2549. https://doi.org/10.1245/s10434-018-6470-1

1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT) : A Feasibility Study. / Moncrieff, Marc D.; Gyorki, David; Saw, Robyn; Spillane, Andrew J.; Peach, Howard; Oudit, Deemesh; Geh, Jenny; Dziewulski, Peter; Wilson, Ewan; Matteucci, Paolo; Pritchard-Jones, Rowan; Olofsson Bagge, Roger; Wright, Frances C.; Crampton, Nic; Cassell, Oliver; Jallali, Navid; Berger, Adam; Kelly, John; Hamilton, Stephen; Durrani, Amer; Lo, Serigne; Paton, Elizabeth; Henderson, Michael A.

In: Annals of surgical oncology, Vol. 25, No. 9, 01.09.2018, p. 2541-2549.

Research output: Contribution to journalArticle

Moncrieff, MD, Gyorki, D, Saw, R, Spillane, AJ, Peach, H, Oudit, D, Geh, J, Dziewulski, P, Wilson, E, Matteucci, P, Pritchard-Jones, R, Olofsson Bagge, R, Wright, FC, Crampton, N, Cassell, O, Jallali, N, Berger, A, Kelly, J, Hamilton, S, Durrani, A, Lo, S, Paton, E & Henderson, MA 2018, '1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study', Annals of surgical oncology, vol. 25, no. 9, pp. 2541-2549. https://doi.org/10.1245/s10434-018-6470-1
Moncrieff, Marc D. ; Gyorki, David ; Saw, Robyn ; Spillane, Andrew J. ; Peach, Howard ; Oudit, Deemesh ; Geh, Jenny ; Dziewulski, Peter ; Wilson, Ewan ; Matteucci, Paolo ; Pritchard-Jones, Rowan ; Olofsson Bagge, Roger ; Wright, Frances C. ; Crampton, Nic ; Cassell, Oliver ; Jallali, Navid ; Berger, Adam ; Kelly, John ; Hamilton, Stephen ; Durrani, Amer ; Lo, Serigne ; Paton, Elizabeth ; Henderson, Michael A. / 1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT) : A Feasibility Study. In: Annals of surgical oncology. 2018 ; Vol. 25, No. 9. pp. 2541-2549.
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abstract = "Background: There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. Methods: This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. Results: Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9{\%}), extremities (35.6{\%}), and head and neck (7.4{\%}). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6{\%}; p < 0.0001). There was an increased wound necrosis rate in the 2-cm arm (0.5 vs. 3.6{\%}; p = 0.036). After 12 months’ follow-up, no differences were noted in QoL between groups. Discussion: This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.",
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T2 - A Feasibility Study

AU - Moncrieff, Marc D.

AU - Gyorki, David

AU - Saw, Robyn

AU - Spillane, Andrew J.

AU - Peach, Howard

AU - Oudit, Deemesh

AU - Geh, Jenny

AU - Dziewulski, Peter

AU - Wilson, Ewan

AU - Matteucci, Paolo

AU - Pritchard-Jones, Rowan

AU - Olofsson Bagge, Roger

AU - Wright, Frances C.

AU - Crampton, Nic

AU - Cassell, Oliver

AU - Jallali, Navid

AU - Berger, Adam

AU - Kelly, John

AU - Hamilton, Stephen

AU - Durrani, Amer

AU - Lo, Serigne

AU - Paton, Elizabeth

AU - Henderson, Michael A.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. Methods: This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. Results: Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p < 0.0001). There was an increased wound necrosis rate in the 2-cm arm (0.5 vs. 3.6%; p = 0.036). After 12 months’ follow-up, no differences were noted in QoL between groups. Discussion: This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.

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