LOCAL EXCISION OF CUTANEOUS MELANOMA WITH SPECIAL REFERENCE TO HEAD AND NECK LOCALIZATION - HOW WIDE

There is a continuing trend towards narrower excision margins in primary melanoma. Based on recently published results of prospective randomized trials, it can be derived that nowadays a 1-cm margin is safe for melanomas not thicker than 1 mm and that such a margin seems to be justified for melanomas between 1.1 and 2 mm. For melanomas between 2 and 4 mm thickness, a 2-cm margin is advocated. There is no information from randomized trials concerning patients with melanomas thicker than 4 mm. The fascia can be left intact, except when there is only a thin subcutaneous fat layer. The development towards narrower excision margins is of utmost importance especially in the treatment of melanomas of the face. However, even with 1- or 2-cm margins, mutilation can often not be avoided. Here, surgeons have to use their best judgement, weighing function and cosmesis against the possible increased risk of local recurrence when performing even narrower excisions than indicated. The trend towards narrower excision margins does not apply to desmoplastic melanoma, a tumour generally located on the face and notorious for its tendency to recur locally. Lentigo maligna melanoma also needs different treatment tailoring because of the frequently large dimensions of the surrounding preinvasive lentigo maligna component.