The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma - An Argument for a More Conservative Approach.

Background: Pediatric melanoma is the most common skin cancer in children. Achieving surgical margins recommended by the National Comprehensive Cancer Network (NCCN) for wide local excision (WLE) is challenging in children with less body domain. This study investigated whether surgical margin impacted postoperative clinical outcomes following WLE for melanoma in children and adolescents.

Methods: All patients ≤21 years undergoing WLE between 2007 and 2023 were analyzed. Patients were categorized in groups of surgical margin <2 cm vs. ≥2 cm. The chi-square test/Fisher's exact test and Mann-Whitney U test were used to analyze categorical and continuous variables between groups. Multivariate logistic regression was used to determine the association of age and tumor location with surgical margin group and whether NCCN guidelines for WLE were met.

Results: Of the 59 patients included, 61% had WLE with <2 cm margins. Head/neck melanomas were less likely to have margins ≥2 cm (OR = 0.121, 95% CI 0.022-0.648, p = 0.014) and margins that met the NCCN guidelines (OR = 0.002, 95% CI 0.003-0.215, p < 0.001) when compared to trunk/extremity primaries. There was no difference in the rate of postoperative complications or need for intervention for complications between patients with margins <2 cm and those with ≥2 cm. No patients experienced local recurrence with a median follow-up of 52 months (IQR: 16 to 93).

Conclusion: Pediatric head/neck melanomas undergoing WLE were likelier to have narrow margins <2 cm and less likely to meet NCCN criteria. Narrow margins may achieve excellent results for pediatric melanoma patients.

Type of study: This is a treatment study.

Levels of evidence: This is a Level III retrospective comparative study.