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Results from a recent article in the journal,

Cancer indicate that patients with melanoma of the skin with a thickness of less than 2 millimeters (mm) can be successfully treated with narrow excision of their cancer.

Standard treatment for the early melanoma that has not spread from its site of origin includes surgical removal of the cancer (excision). Historically, a large diameter of healthy tissue surrounding the cancer was excised (wide excision) along with the primary cancer to increase the likelihood of all cancerous cells being removed. More recently, physicians have been using narrow excision, or the removal of a lesser amount of healthy tissue surrounding the cancer for the treatment of early stage melanoma. Results from a recent study published in the journal

Cancer indicate the use of narrow excision for early stage melanoma results in the same cure rates for patients as the use of wide excision with fewer side effects. These findings are consistent with other clinical trials that have evaluated the same procedure.

Melanoma is a cancer of the skin that usually begins in the form of a mole. The cancer can grow deep into the skin and spread to different parts of the body through blood or lymph vessels. Early stage melanoma (stage I and stage II) refers to cancer that is confined to the skin and is less than 4 mm thick. The removal of healthy tissue surrounding the cancer increases the chance of a cure by removing the largest number of cancerous cells that may have spread away from the primary cancer. However, wide excisions are associated with the potential development of side effects that may include infection, pain and scarring, sometimes severe enough to require skin grafting. By gradually evaluating less extensive surgeries, doctors hope to define the optimal amount of healthy tissue that can be removed while maintaining the greatest chance of a cure.

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The Swedish Melanoma Study Group recently performed a multi-center study involving almost 1,000 patients with melanoma located on the trunk or extremities with a thickness between .8 and 2 mm. Half of the patients received a wide excision (over 2 inches) to remove their cancer and the other half received narrow excision (less than 1 inch). Eleven years following treatment, no differences were found in the cure rates between the two groups of patients. Overall, 20% of these patients experienced a cancer recurrence, with less than 1% of these patients experiencing a local cancer recurrence.

These results aid in the confirmation that narrow excision for early stage melanoma is just as effective as wide excision, while sparing patients from adverse side effects caused by wide excisions. Persons with early stage melanoma may wish to speak with their doctor about the risks and benefits of narrow excision or about the participation in a clinical trial utilizing other promising treatment strategies. Two sources of information on ongoing clinical trials that can be discussed with a physician include comprehensive, easy-to-use services provided by the National Cancer Institute

( and also provides personalized clinical trial searches on behalf of patients. (

Cancer, Vol 89, No 7, pp 1495-1501, 2000)

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