Surgical Margins in Cutaneous Melanoma
The definitive treatment for primary cutaneous melanoma is wide local excision. Margin width is determined by the Breslow thickness of the tumor.
Current Guidelines (2024 Consensus)
Following diagnostic excision biopsy (typically 2mm margins), a wide local excision (WLE) is performed. The recommended clinical margins are:
| Melanoma Type / Breslow Thickness | Recommended Clinical Margin |
|---|---|
| Melanoma in situ (Stage 0) | 5 mm |
| ≤ 1.0 mm (Stage T1) | 1 cm |
| 1.01 mm to 2.0 mm (Stage T2) | 1 to 2 cm |
| > 2.0 mm (Stage T3, T4) | 2 cm |
Narrower Margins Trial (MelMarT)
Ongoing international trials (like the MelMarT-II trial) are investigating whether 1cm margins are non-inferior to 2cm margins for melanomas thicker than 1mm, aiming to reduce surgical morbidity. Until conclusive results are published, 2cm remains standard for >2mm lesions.