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

Infographic · May 2025 · 1 min read

In brief

Study of 59 pediatric melanoma patients demonstrates that narrow surgical margins (<2 cm) in wide local excision achieve excellent outcomes with no local recurrence at 52-month median follow-up. Head and neck melanomas were less likely to meet NCCN margin guidelines but showed comparable safety, supporting more conservative approaches in children.

61% of pediatric melanoma WLE cases used margins <2cm, with no local recurrence observed at median 52-month follow-up.
Head/neck melanomas were significantly less likely to achieve NCCN-recommended margins compared to trunk/extremity lesions.
Narrow surgical margins (<2cm) showed no difference in complication rates or need for intervention versus wider margins (≥2cm).
Conservative margin approach may be appropriate for pediatric melanoma given anatomic constraints and excellent outcomes with <2cm margins.
NCCN guideline adherence was challenging in pediatric patients, particularly for head/neck primaries, without compromising oncologic safety.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with medical illustrations of esophageal procedures. Each column contains anatomical diagrams in blue and pink tones showing the esophagus and stomach, with surgical technique variations. Bar charts or percentage indicators display outcome metrics below each 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.

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