Employing skin self-examination and fear of cancer recurrence management in early-stage melanoma follow-up: Evaluation of the MELACARE intervention in a randomised controlled trial

The weighted 10-year local recurrence rate for wide and narrow group was 5.7% (3.9-8.3%) and 6.7% (4.7-9.5%) for T1a; 5.4% (3.7-8.1%) and 6.4% (4.5-9.2%) for T1b-T2; 5.4% (3.2-9.2%) and 8.8% (6.4-12.1%)for T3-T4, respectively.Of the 1054 patients in the wide group, 622 (59%) had linear repair and 432 (41%) required reconstruction with a skin graft or flaps.Of the 1156 narrow-group patients, 881 (76.2%) had linear repair and 275 (23.8%) required a skin graft or flaps.The difference in reconstruction frequency between groups was significant (p<.001). Conclusions:Local excision with 5-mm margins for T1-T2 melanoma and with 10-mm margins for T3-T4 melanoma occuring at critical sites was not associated with worse outcome, but with significantly fewer reconstructive surgery.Since this was demonstrated for melanomas at difficult anatomic locations, there is no plausible reason to assume it could not be extrapolated to all other sites.Finally, our findings provide support for prospective randomized clinical trials to definitively answer the important question about appropriate margins for primary melanomas.