Background: Surgical treatment of acral lentiginous melanomas with wide excisional margins as recommended often requires amputation of distal extremities. The current study analyzes, if smaller excisions in combination with a complete histological evaluation of the excisional margins (3D histology) have a negative impact on the prognosis.
Patients and methods: 304 patients were retrospectively evaluated. 192 patients with reduced excisional margins followed by 3D histology (group A) were compared with 112 patients treated with conventional wide margins (group B). The outcome of both groups was compared.
Results: The median tumor thickness was higher in group A (p = 0.022) and ulcerations occured more frequently (p = 0.017). The median excisional margin was 8 mm in group A and 20 mm in group B (p < 0.0001). 10.9 % (4.2 % invasive) of group A und 8.9 % (4.5 %invasive) of group B (p = 0.577) developed a local recurrence in a median of 40 months.The melanoma specific 10-year survival was 66.8 % in group A und 63.4 % in group B(p = 0.531). Survival of patients with or without local recurrence showed no difference(p = 0.643).
Conclusions: Excision with small margins followed by 3D histology is not inferior to conventional surgery with wide margins concerning the rate of local recurrences and has no negative impact on prognosis or the further course of the disease. Local recurrences are rare and do not influence the survival.