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<p>Wide local excision (WLE) is essential in melanoma treatment to achieve clear margins. However, consensus on optimal excision margins to prevent local recurrence (LR) and increase melanoma-specific survival (MSS) is lacking. The aim of this study was to investigate the effect of surgical margins on LR and 5-year MSS in the treatment of patients with stage II melanoma (pT2b-pT4b, AJCC 8th edition). A literature search was performed in PubMed, EMBASE and Cochrane Library in October 2023. The network meta-analysis (NMA) was performed on LR and MSS, implementing a random effects model. A meta-regression analysis was performed to explore the association between margins and treatment effect. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used. A total of 12 articles with 3988 patients were included. Margins of 1 cm compared to margins of 4 cm resulted in a higher OR for LR (OR 2.61; 95%CI [1.13–6.02]). MSS showed no statistically significant differences between 1 and 2 cm group (OR 1.22; 95%CI [0.86–1.74]). Comparable results for MSS were found comparing 1 cm versus 4 cm (OR 1.36; 95%CI [0.86–2.13]). The meta-regression showed a significant negative association between WLE margins and LR: OR = 0.45 per additional cm (95%CI [0.23–0.90], <i>p</i> = 0.023). Although 1 cm margins may not yet be established as standard care, the NMA offers an attractive alternative to summarize present findings and complement ongoing RCTs. Based on these results, a smaller margin tends to increase LR, but does not impact the MSS. This emphasizes the importance of the final results in the MelMarT-II study.</p>

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Wide local excision margins in melanoma: a systematic review and network meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Loeki Aldenhoven,
  • Jans Hameleers,
  • Nick Servaas,
  • Merel A. Spiekerman van Weezelenburg,
  • Sander M. J. van Kuijk,
  • Elisabeth R. M. van Haaren,
  • Alfred Janssen,
  • Yvonne L. J. Vissers,
  • Geerard L. Beets,
  • James van Bastelaar

摘要

Wide local excision (WLE) is essential in melanoma treatment to achieve clear margins. However, consensus on optimal excision margins to prevent local recurrence (LR) and increase melanoma-specific survival (MSS) is lacking. The aim of this study was to investigate the effect of surgical margins on LR and 5-year MSS in the treatment of patients with stage II melanoma (pT2b-pT4b, AJCC 8th edition). A literature search was performed in PubMed, EMBASE and Cochrane Library in October 2023. The network meta-analysis (NMA) was performed on LR and MSS, implementing a random effects model. A meta-regression analysis was performed to explore the association between margins and treatment effect. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used. A total of 12 articles with 3988 patients were included. Margins of 1 cm compared to margins of 4 cm resulted in a higher OR for LR (OR 2.61; 95%CI [1.13–6.02]). MSS showed no statistically significant differences between 1 and 2 cm group (OR 1.22; 95%CI [0.86–1.74]). Comparable results for MSS were found comparing 1 cm versus 4 cm (OR 1.36; 95%CI [0.86–2.13]). The meta-regression showed a significant negative association between WLE margins and LR: OR = 0.45 per additional cm (95%CI [0.23–0.90], p = 0.023). Although 1 cm margins may not yet be established as standard care, the NMA offers an attractive alternative to summarize present findings and complement ongoing RCTs. Based on these results, a smaller margin tends to increase LR, but does not impact the MSS. This emphasizes the importance of the final results in the MelMarT-II study.