• Olivia Ruskin, Alexandra Sanelli, Alan Herschtal, Angela Webb, Ben Dixon, Miklos Pohl, Simon Donahoe, John Spillane, Michael A Henderson, and David E Gyorki.
• Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
• Head Neck. 2016 Sep 1; 38 (9): 1373-9.

BackgroundRecommended margins for thick cutaneous melanoma (Breslow thickness >4 mm; T4) have decreased over recent decades. Optimal margins and the role of sentinel node biopsy (SNB) in thick head and neck melanoma remain controversial.MethodsA single-center review was conducted of patients treated between 2002 and 2012 assessing the impact of excision margins and sentinel lymph node status on locoregional recurrence and melanoma-specific survival (MSS).ResultsOne hundred eight patients were identified. Median age was 71.1 years and median Breslow thickness was 6.0 mm. Median follow-up was 40 months. Locoregional recurrence occurred in 27% and there was no significant reduction in recurrence with margins ≥2 cm (p = .17). Increasing margins did not improve survival (p = .58). Fifty-nine patients (55%) underwent SNB, of which 27% were positive. There was a trend toward longer survival for patients who were sentinel lymph node-negative (p = .097).ConclusionWider margins do not significantly improve locoregional recurrence or MSS. Sentinel lymph node involvement reflects a poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1373-1379, 2016.© 2016 Wiley Periodicals, Inc.

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