Recommended Minimum Surgical Margin to Remove Skin Cancer

A surgical margin of at least two millimetres around a cancerous skin lesion is the minimum requirement to ensure total removal of cancer cells and to avoid the need for further surgeries, according to a study by researchers at Perlmutter Cancer Center at NYU Langone Health.

The results of a study enlisting 138 skin cancer patients was published in the Journal of the American Academy of Dermatology, and found that excising a two millimetre margin beyond the edges of a suspicious mole was best practice for complete removal.

Researchers said that such margin guidelines are needed because up to two-thirds of suspicious moles removed each year in the United States require further surgery because cancer cells have been missed in the first attempt. The second procedure involves more risk of infection, bleeding and scarring, and puts the patient through the inconvenience of a further treatment and unnecessary costs.

“Once the decision has been made to remove a mole, there should be a clearer standard margin,” says senior study investigator and dermatologist Davis Polsky. He says that currently, most physicians cut a very small, imprecise one millimetre margin around the mole’s edge, and this is often insufficient.

The study showed that a ‘one and done’ approach with a clearly defined, slightly larger margin is safer and more effective in completely removing the lesion in a single procedure.

Researchers removed 151 suspicious moles from the arms, legs and backs of 138 patients. Each patient underwent a biopsy procedure involving complete mole removal with a two millimetre surgical margin, and were monitored for 18 months post-procedure. None had further suspicious growths at the biopsy sites.

Ninety percent of the biopsied moles were completely removed by using the single procedure, with seven percent diagnosed as melanoma.

“The common practice of removing moles with narrow margins and performing a second ‘clean-up’ procedure suggests a need to move toward wider margins during the initial procedure,” says Dr Polsky.

He says if further data support the current findings, he hopes that other cancer centres will also adopt his ‘one and done’ approach, and, if so, he will recommend changes to the next edition of surgical margin practice guidelines issued by the American Academy of Dermatology.

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Press release. (October 5, 2017.) Doctors define margins for skin removal around suspicious moles. Prime Journal.

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