Original CommunicationPreservation of the deep muscular fascia and locoregional control in melanoma
Section snippets
Methods
We performed an institutional research board–approved retrospective review of all patients age 18 or older with a primary cutaneous melanoma ≥1 mm in Breslow depth, located on the trunk or extremities, who underwent wide local excision at Mayo Clinic, Rochester, MN, from 1980 to 2008 and Mayo Clinic, Scottsdale, AZ, from 1997 to 2008. Patients in whom resection or preservation of the deep muscular fascia was not clearly defined as well as those who underwent amputation were excluded. Primary
Results
A total of 964 patients (661 undergoing resection at Mayo Clinic Rochester and 303 from Mayo Clinic Scottsdale) who met all inclusion and exclusion criteria were included in this analysis. The median follow-up was 61 months for the entire cohort and 77 months for the 592 survivors. The median age was 57 years (range, 18–93). The median Breslow depth was 2.0 mm (range, 1–40 mm), and 140 (15%) patients had nodal metastasis at presentation. Peripheral margins were negative in all cases, and the
Discussion
Our data demonstrate that removing the muscular fascia at the time of primary excision for melanoma of the trunk and extremity does not improve overall survival or local recurrence. This finding is also consistent with a recent trial in which the authors addressed fascia resection and local recurrences in patients with breast cancer; patients were randomized to preservation or resection of the pectoralis fascia, and the authors demonstrated that local chest wall recurrence was not substantially
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Update on surgical treatment of primary and metastatic cutaneous melanoma
2016, Cirugia y CirujanosA retrospective study of 1- Versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm
2015, Journal of the American Academy of DermatologyCitation Excerpt :In the current study, local recurrences can represent either persistent disease caused by inadequate initial excision or true recurrence adjacent to the scar after adequate prior wide local excision and usually have an in situ component, or they may represent satellite metastases. Locoregional recurrence of melanoma after initial resection was defined as recurrence at the site of the primary lesion, regionally in the draining lymph node basin, or anywhere in between (local recurrence cases were not included).8-10 Spreading from the original (primary) tumor to distant organs or distant lymph nodes was considered as distant metastases.11
Surgical Management of Melanoma
2014, Hematology/Oncology Clinics of North AmericaCitation Excerpt :Radical excision indicates that the removal of normal tissue extends down to the level of the underlying muscular fascia, in contrast with the more limited amount of subcutaneous tissue that is normally excised in treatment of a typical nonmelanoma skin cancer–like basal or squamous cell carcinoma. It has never been shown that removing the muscular fascia is necessary for the success of the procedure,1,2 and practice patterns differ in whether to always, never, or selectively remove the underlying fascia.3 The width of excision for an invasive primary melanoma is based on data derived from a series of randomized controlled trials,4 and the recommended width of excision increases for thick primary tumors within the limits of anatomic constraints.5
Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: Definitive excision margins for primary cutaneous melanoma
2018, Medical Journal of AustraliaCitation Excerpt :No RCTs have assessed depth of excision. Recent non-randomised studies suggest that excision of the deep fascia does not improve the outcome for melanomas thicker than 1 mm23 or 2 mm;21 however, results of these retrospective studies must be interpreted with caution. The depth of excision in usual clinical practice is excision down to but not including the deep fascia, unless the fascia is involved with tumour or if removal of it is technically warranted.
Current surgical management for melanoma
2024, Journal of DermatologyENT management of head and neck cutaneous melanoma
2020, Revue Medicale Suisse