Many skin cancer patients fare just as well when surgeons remove about one inch of normal-looking tissue around the lesion instead of a larger safety margin, according to a new systematic review.
Cutaneous melanoma arises in pigment-producing cells and is associated with sun exposure, so primary tumors are often on the face and hands where patients have special concerns about unsightly scars.
The purpose of the safety margin is to remove both the primary tumor and any malignant cells that might have spread into the surrounding skin. Combined data from five studies suggested a slight benefit to wider surgical margins, but the difference was not statistically significant, the review says.
"The most important consideration is to make sure that [the lesion] is removed with as much certainty as possible," write authors led by Michael Sladden, M.D., of the University of Tasmania in Australia. "However, quality of life after surgery is an important consideration and unnecessary disfigurement should be avoided."
The bottom line for people with skin cancer is that individualized treatment is critical, say surgical oncologists who were not involved in the review.
"Patients should be sure they are being treated by physicians who are very knowledgeable about melanoma so they don't get over- or under-treated," said Vernon Sondak, M.D., of the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla. "They should seek out a very qualified team that includes pathologists as well as surgeons."
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Melanoma is the most serious type of skin cancer, and the percentage of Americans who develop the disease has more than doubled in the past 30 years, according to the National Cancer Institute. Unlike many other common cancers, melanoma affects people across a wide age spectrum. While occurrence rates are highest among senior citizens, it is also one of the more common cancers in adolescents and young adults.
The systematic review analyzed five studies of patients with moderately severe melanoma, where the tumor has invaded the deeper layers of skin, but has not spread to other organs. Charles Balch, a review co-author, was lead author on one of the review studies.