Preservation of the deep muscular fascia and locoregional control in melanoma

Travis E. Grotz, Jaime M. Glorioso, Barbara A Pockaj, William S. Harmsen, James W Jakub

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Locoregional recurrence occurs in approximately 20% of patients with melanoma and is associated with a significantly worse prognosis. Standards are well established for peripheral margins; however, there is insufficient evidence regarding depth of resection. Methods: Retrospective review of 964 patients undergoing excision of trunk or extremity melanoma ≥1 mm thick during a 29-year period at a tertiary academic center. Multivariate analysis and hazard ratios were used to determine the effect of excision of the deep muscular fascia on locoregional recurrence. Results: A total of 278 (29%) patients underwent resection of the muscular fascia. Of these patients, 18 (6%) developed local, 33 (12%) developed in-transit, and 68 (24%) developed nodal recurrence within 5 years. A total of 686 (71%) patients underwent excision of their primary melanoma with preservation of the muscular fascia. Of these patients, 40 (6%) developed local, 30 (4%) developed in-transit, and 84 (12%) developed nodal recurrence at 5 years. In multivariate analysis excision of the deep muscular fascia was an independent predictor of locoregional recurrence in patients treated with sentinel lymph node biopsy. Specifically, fascia resection was associated with a 2.5-fold increased risk of nodal recurrence but not associated with local recurrence or overall survival. Conclusion: On the basis of no demonstrated advantage for resection of the deep muscular fascia, but potential for increased risk of intralymphatic recurrences, we recommend preservation of the deep muscular fascia during resection of primary cutaneous melanoma.

Original languageEnglish (US)
Pages (from-to)535-541
Number of pages7
JournalSurgery (United States)
Volume153
Issue number4
DOIs
StatePublished - Apr 2013

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Fascia
Melanoma
Recurrence
Multivariate Analysis
Sentinel Lymph Node Biopsy
Extremities
Skin
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Preservation of the deep muscular fascia and locoregional control in melanoma. / Grotz, Travis E.; Glorioso, Jaime M.; Pockaj, Barbara A; Harmsen, William S.; Jakub, James W.

In: Surgery (United States), Vol. 153, No. 4, 04.2013, p. 535-541.

Research output: Contribution to journalArticle

Grotz, Travis E. ; Glorioso, Jaime M. ; Pockaj, Barbara A ; Harmsen, William S. ; Jakub, James W. / Preservation of the deep muscular fascia and locoregional control in melanoma. In: Surgery (United States). 2013 ; Vol. 153, No. 4. pp. 535-541.
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abstract = "Background: Locoregional recurrence occurs in approximately 20{\%} of patients with melanoma and is associated with a significantly worse prognosis. Standards are well established for peripheral margins; however, there is insufficient evidence regarding depth of resection. Methods: Retrospective review of 964 patients undergoing excision of trunk or extremity melanoma ≥1 mm thick during a 29-year period at a tertiary academic center. Multivariate analysis and hazard ratios were used to determine the effect of excision of the deep muscular fascia on locoregional recurrence. Results: A total of 278 (29{\%}) patients underwent resection of the muscular fascia. Of these patients, 18 (6{\%}) developed local, 33 (12{\%}) developed in-transit, and 68 (24{\%}) developed nodal recurrence within 5 years. A total of 686 (71{\%}) patients underwent excision of their primary melanoma with preservation of the muscular fascia. Of these patients, 40 (6{\%}) developed local, 30 (4{\%}) developed in-transit, and 84 (12{\%}) developed nodal recurrence at 5 years. In multivariate analysis excision of the deep muscular fascia was an independent predictor of locoregional recurrence in patients treated with sentinel lymph node biopsy. Specifically, fascia resection was associated with a 2.5-fold increased risk of nodal recurrence but not associated with local recurrence or overall survival. Conclusion: On the basis of no demonstrated advantage for resection of the deep muscular fascia, but potential for increased risk of intralymphatic recurrences, we recommend preservation of the deep muscular fascia during resection of primary cutaneous melanoma.",
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