Poster Presentation Australasian Melanoma Conference 2018

A randomised trial of excision margins for melanoma (ANZMTG 03.12 MelMarT) (#102)

Marc D Moncrieff 1 , David E Gyorki 2 , Alex Economides 3 , Evan Buck 3 , Robyn PM Saw 4 , Andrew J Spillane 4 , John F Thompson 4 , Howard Peach 5 , Deemesh Oudit 6 , Jenny Geh 7 , Peter Dziewulski 8 , Ewan Wilson 9 , Paolo Matteucci 10 , Rowan Pritchard-Jones 11 , Roger Olofsson Bagge 12 , Frances C Wright 13 , Nic Crampton 14 , Oliver Cassell 15 , Navid Jallali 16 , Adam Berger 17 , John Kelly 18 , Stephen Hamilton 19 , Amer Durrani 20 , Serigne Lo 4 , Elizabeth Paton 3 , Michael A Henderson 2
  1. Norfolk & Norwich University Hospital, Norwich, UK
  2. Peter MacCallum Cancer Centre, Melbourne, Australia
  3. Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, NSW, Australia
  4. Melanoma Institute Australia, Sydney, Australia
  5. Leeds Teaching Hospitals, Leeds, UK
  6. Christie NHS Trust, Manchester, UK
  7. Guy's & St Thomas' NHS Trust, London, UK
  8. St Andrew's Centre for Burns & Plastic Surgery, Chelmsford, UK
  9. North Bristol NHS Trust, Bristol, UK
  10. Hull & East Yorkshire NHS Trust, Hull, UK
  11. Mersey Centre for Burns & Plastic Surgery, Liverpool, UK
  12. Sahlgrenska University Hospital, Göteborg, Sweden
  13. Sunnybrook Health Sciences Centre, Toronto, Canada
  14. Gold Coast Melanoma Clinic, Gold Coast, Australia
  15. Oxford University Hospitals NHS Trust, Oxford, UK
  16. Imperial Hospital NHS Trust, London, UK
  17. Jefferson University Hospitals, Philadelphia, USA
  18. The Alfred Hospital, Melbourne, Australia
  19. Royal Free Hospital NHS Trust, London, UK
  20. Cambridge University Hospitals, Cambridge, UK


There is a lack of consensus regarding the optimal surgical excision margins for the management of primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost, with no effect on survival outcomes. We report the results of an international pilot study (MelMarT) comparing 1 and 2-cm surgical excision margins for patients with primary melanoma > 1 mm in BT.



This phase III, multicentre trial [NCT02385214; ACTRN12614000667617] coordinated by the Australia and New Zealand Melanoma Trials Group (ANZMTG 03.12), randomised patients with a primary cutaneous melanoma > 1 mm in BT 1:1 to a 1 versus 2-cm wide excision margin to be performed with staging sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients’ QoL was measured (FACT-M, PainDetect, EQ-5D-5L questionnaires) at baseline, and 3, 6, and 12 months after randomisation.



Between January 2015 and June 2016, 400 patients were randomised from 19 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p < 0.0001). There was an increased wound necrosis rate in the 2-cm arm (3.6% v 0.5% p = 0.036). After 12 months of follow-up, no differences were noted in QoL between groups.



This pilot study demonstrates the feasibility of a large international randomised controlled trial to provide a definitive answer to the question of the optimal surgical excision margins for patients with intermediate- to high-risk primary cutaneous melanoma. A full cohort of 2,998 patients (ANZMTG 04.18 MelMarT-II) will be required to demonstrate non inferiority of a 1-cm margin.