Reducing margins of wide local excision in head and neck melanoma for function and cosmesis: 5-year local recurrence-free survival

Background The proximity of head and neck (H&N) melanomas to critical anatomical structures requires that surgeons achieve a balance between adequate margins of excision and the functional and cosmetic needs of patients. This study sought to determine the risk associated with reducing margins of wide local excision (WLE) in H&N melanoma and to identify risk factors of recurrence. Methods Seventy-nine cases of primary, invasive H&N melanoma were treated by WLE and followed prospectively for local recurrence. Forty-two WLEs were performed according to current practice guidelines (1cm for lesions<1.0mm thick, 1-2cm for lesions 1.01-2.0mm thick, and 2cm for lesions >2.0mm thick). Reduced margins (0.5cm for lesions ≤1.0mm thick, 0.5-1.0cm for lesions 1.01-2.0mm thick, and 1.0cm for lesion >2.0mm thick) were utilized in 37 cases to preserve critical anatomical structures such as the eyelid, nose, mouth and auricle. Results Overall local recurrence rate was 8.9% over a mean follow-up period of 71.3 months and a minimum of 60 months. Reducing margins of WLE did not increase local recurrence rates as demonstrated by local recurrence-free survival (90.4% vs. 91.9%, P=0.806). Conclusion Margins of WLE may be safely reduced in melanomas in close proximity to structures of the H&N without affecting local recurrence rates.