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Recommended Margins for Wide Local Excision of a Primary Malignant Melanoma

Description

Wide excision about a melanoma is intended to aid in local control and to prevent satellite nodules. The radius of wide excision about a melanoma depends on the thickness of tumor invasion in mm. Patients with tumors 1 mm or more in thickness also undergo evaluation for metastases, which may include lymphatic mapping and sentinel node biopsy.


 

NOTE: Recommendations for excising melanomas 1-4 mm in thickness are given in 27.48.07 (above).

Thickness of Invasion

Margin Radius

0 (in situ)

0.5 cm

< 1.0 mm

1.0 cm

1.0 - 1.99 mm

2.0 cm

2.0 - 4.0 mm

2.0 cm

> 4.0 mm

> 2.0 cm

 

The radius is measured from either the edge of the melanoma or the scar of a previous site.

 

The surgical margins of the wide excision must be negative.

 

The actual width of the excision may be adjusted for cosmetic or anatomic reasons. A narrower margin may slightly increase the risk of local recurrence.

 

The depth of excision extends down to the superficial fascia.

 

A subungual melanoma is treated by amputation of the distal digit to provide a 1 cm margin from the tumor, typically through the distal PIP joint.

 


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