How wide should surgical margins be?

There is ongoing controversy regarding the width of normal-appearing skin that should be excised. At one time, 5.0-cm margins were recommended. With the exception of only four prospective multicenter trials, surgical margins were originally based, at least in part, on consensus decision and tradition. A National Institutes of Health Consensus Conference on Melanoma has recommended surgical margins based on the depth of invasion of the primary tumor. Malignant melanoma in situ should be excised with a 0.5-cm border of normal skin. Lesions that have a Breslow’s depth of 1.0 mm should have wide local reexcision with 1.0-cm margins. Lesions that are 1 to 2 mm thick should be excised with 1- to 2-cm margins (2 cm, if primary closure can be achieved, or no significant difference exists in reconstruction between a 1- and 2-cm margin of excision). Lesions that are intermediate, 2 to 4 mm thick, are excised with 2-cm margins. Lesions 4.0 mm thick should be excised with 2- to 3-cm margins; there are no randomized trials that have determined the optimal margins for excision of melanoma >4 mm in thickness. These recommendations are meant only as general guidelines, and individual patient considerations must be taken into account. It should be stressed that there are several studies demonstrating that 0.5-cm margins are inadequate for most malignant melanoma in situ on the head, neck, hands, and feet. Moreover, there is evidence to suggest that tumor thickness should not influence surgical margins.


Studies suggest that definitive surgical treatment may be delayed up to 3 weeks after biopsy of the primary lesion without adversely affecting the 5-year survival rate.

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Thompson JF, Scolyer RA, Uren RF: Surgical management of primary cutaneous melanoma: excision margins and the role of sentinel lymph node examination, Surg Oncol Clin N Am 15:301–318, 2006.