The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma – An Argument for a More Conservative Approach
Topic overview
Study of 59 pediatric melanoma patients demonstrates that narrow surgical margins (<2 cm) in wide local excision achieve excellent outcomes with no local recurrence at 52-month median follow-up. Head and neck melanomas were less likely to meet NCCN margin guidelines but showed comparable safety, supporting more conservative approaches in children.
Key takeaways
- 61% of pediatric melanoma WLE cases used margins <2cm, with no local recurrence observed at median 52-month follow-up.
- Head/neck melanomas were significantly less likely to achieve NCCN-recommended margins compared to trunk/extremity lesions.
- Narrow surgical margins (<2cm) showed no difference in complication rates or need for intervention versus wider margins (≥2cm).
- Conservative margin approach may be appropriate for pediatric melanoma given anatomic constraints and excellent outcomes with <2cm margins.
- NCCN guideline adherence was challenging in pediatric patients, particularly for head/neck primaries, without compromising oncologic safety.
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