Câncer/Oncologia/Tumor

Existe controvérsia no que diz respeito à margem de excisão necessária para um melanoma cutâneo com 2 mm ou mais de espessura. A fim de maior elucidação, um grupo de pesquisadores ingleses realizou este estudo, recentemente publicado no The New England Journal of Medicine.

O estudo comparativo foi conduzido com 900 pacientes, sendo que destes, 453 foram designados ao acaso para a cirurgia com margem de excisão de 1 cm e 447 para a cirurgia com 3 cm. O acompanhamento médio foi de 60 meses.

A margem de 1 cm de excisão foi associada com um risco significativamente aumentado de recorrência locoregional, aparecendo 168 recorrências neste grupo, contra 142 no grupo com 3 cm (razão de risco, 1,26; intervalo de confiança de 95%, 1,00 a 1,59; P = 0,05). Houve 128 mortes atribuíveis ao melanoma no grupo com 1 cm e 105 no grupo com 3 cm (razão de risco, 1,24; intervalo de confiança de 95%, 0,96 a 1,61; P = 0,1); a sobrevivência total foi similar nos dois grupos (razão de risco para morte, 1,07; intervalo de confiança de 95%, 0,85 a 1,36; P = 0,6).

Os autores concluíram que uma margem de excisão de 1 cm para melanoma com fraco prognóstico (como definido por um tumor com espessura de pelo menos 2 mm) está associada com um risco significativamente maior de recorrência regional do que uma margem de 3 cm, mas com uma taxa de sobrevivência total similar.

Excision Margins in High-Risk Malignant Melanoma - The New England Journal of Medicine

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Previous Volume 350:757-766 February 19, 2004 Number 8 Next

Table of Contents Full Text of this article PDF of this article PDA version of this article Editor's Summary CME Exam Related editorials in the Journal: Krown, S. E. Find Similar Articles in the Journal Notify a friend about this article Journal Watch Dermatology Summary Journal Watch (General) Summary Add to Personal Archive Download to Citation Manager Alert me when letters appear Alert me when this article is cited ISI Web of Science Related Articles Citing Articles (1) Related Articles in Medline Articles in Medline by Author: Thomas, J. M. Medline Citation Dermatology Oncology Surgery Related Chapters at Harrison's Online

Background Controversy exists concerning the necessary margin of excision for cutaneous melanoma 2 mm or greater in thickness.

Methods We conducted a randomized clinical trial comparing 1-cm and 3-cm margins.

Results Of the 900 patients who were enrolled, 453 were randomly assigned to undergo surgery with a 1-cm margin of excision and 447 with a 3-cm margin of excision; the median follow-up was 60 months. A 1-cm margin of excision was associated with a significantly increased risk of locoregional recurrence. There were 168 locoregional recurrences (as first events) in the group with 1-cm margins of excision, as compared with 142 in the group with 3-cm margins (hazard ratio, 1.26; 95 percent confidence interval, 1.00 to 1.59; P=0.05). There were 128 deaths attributable to melanoma in the group with 1-cm margins, as compared with 105 in the group with 3-cm margins (hazard ratio, 1.24; 95 percent confidence interval, 0.96 to 1.61; P=0.1); overall survival was similar in the two groups (hazard ratio for death, 1.07; 95 percent confidence interval, 0.85 to 1.36; P=0.6).

Conclusions A 1-cm margin of excision for melanoma with a poor prognosis (as defined by a tumor thickness of at least 2 mm) is associated with a significantly greater risk of regional recurrence than is a 3-cm margin, but with a similar overall survival rate.

Source Information

From the Royal Marsden Hospital National Health Service Trust, London (J.M.T., R.A.); the Division of Genetic Epidemiology, Cancer Research UK, Clinical Center, Leeds, Yorkshire (J.N.-B.); the Institute of Cancer Research, Sutton, Surrey (G.C., J.M.B.); Bradford Royal Infirmary, Bradford, Yorkshire (M.T.); Nuffield Hospital, Plymouth, Devon (J.E.); Royal Surrey Hospital, Guildford, Surrey (M.C.); Southampton General Hospital, Southampton, Hampshire (J.T.); Broomfield Hospital, Colchester, Essex (M.F.); and Norfolk and Norwich Hospital, Norwich, Norfolk (T.O.) — all in the United Kingdom; and the Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (W.R.).