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Impact of reducing the deep excision margin in the 5-year local and locoregional recurrence and 5-year overall and local recurrence-free survival of patients with primary cutaneous melanoma
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Introdução: A excisão local alargada é o tratamento cirúrgico de eleição do melanoma cutâneo primário, mas as diretrizes práticas não recomendam uma profundidade de excisão específica. Alguns estudos sugerem que a ressecção da fascia muscular profunda associa-se a um aumento da taxa de recidiva locoregional. Este estudo tem como objetivo comparar as taxas de recidiva local e locoregional a 5 anos e as taxas de sobrevivência global e sobrevivência livre de recidiva local a 5 anos de doentes submetidos a excisão local de melanoma com uma margem profunda > 10 mm ou £ 10 mm. Métodos: Foi efetuada uma revisão retrospectiva dos registos patológicos, clínicos e cirúrgicos do ano de 2017 do Painel Multidisciplinar de Cancro Cutâneo do IPO Lisboa. Resultados: A comparação entre os grupos de doentes não foi possível. No entanto, no grupo de doentes submetidos a excisão local alargada com margem profunda £ 10 mm, observámos uma taxa de recidiva local e locoregional a 5 anos de 12,2% e 41,5%, respetivamente. A taxa de sobrevivência global e sobrevivência livre de recidiva local a 5 anos foi de 70,7% e 93,1%, respetivamente. Discussão: Os resultados deste estudo mostraram-se inferiores em comparação com a literatura, se bem que a sua interpretação é limitada por um viés de seleção e reduzido poder estatístico. Sugerimos a realização de estudos adicionais acerca da margem profunda de excisão do melanoma, de modo a que no futuro se possam formular recomendações específicas.
Introduction: Wide local excision is the surgical treatment of election for primary cutaneous melanoma, but no practice guidelines recommend a specific depth of excision. Some studies suggest that resection of the deep muscular fascia is associated with an increased locoregional recurrence rate. The aim of this study is to compare the 5-year local and locoregional recurrence and 5-year overall and local recurrence-free survival rates of patients submitted to melanoma excision with a depth > 10 mm or £ 10 mm. Methods: We performed a retrospective review of pathology, clinical and surgical records from the year of 2017 of the Multidisciplinary Skin Cancer Board in IPO Lisboa. Results: A comparison between patient groups was not possible. However, in the group submitted to WLE with a depth £ 10 mm, we estimated 5-year local and locoregional recurrence rates of 12,2% and 41,5%, respectively. The 5-year overall and local recurrence-free survival rates were 70,7% and 93,1%, respectively. Discussion: The inferior outcomes in this study compared to the literature are limited by selection bias and reduced statistical power. We suggest conducting additional research about the deep excision margin of melanoma until specific recommendations can be issued.
Introduction: Wide local excision is the surgical treatment of election for primary cutaneous melanoma, but no practice guidelines recommend a specific depth of excision. Some studies suggest that resection of the deep muscular fascia is associated with an increased locoregional recurrence rate. The aim of this study is to compare the 5-year local and locoregional recurrence and 5-year overall and local recurrence-free survival rates of patients submitted to melanoma excision with a depth > 10 mm or £ 10 mm. Methods: We performed a retrospective review of pathology, clinical and surgical records from the year of 2017 of the Multidisciplinary Skin Cancer Board in IPO Lisboa. Results: A comparison between patient groups was not possible. However, in the group submitted to WLE with a depth £ 10 mm, we estimated 5-year local and locoregional recurrence rates of 12,2% and 41,5%, respectively. The 5-year overall and local recurrence-free survival rates were 70,7% and 93,1%, respectively. Discussion: The inferior outcomes in this study compared to the literature are limited by selection bias and reduced statistical power. We suggest conducting additional research about the deep excision margin of melanoma until specific recommendations can be issued.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Melanoma Excisão Margens Recidiva Sobrevivência