ABSTRACT
BACKGROUND: NCCN guidelines recommend 1 or 2 cm margins for melanomas 1-2 mm (T2 melanomas) in depth; however, no head-to-head comparison has been performed. We hypothesized 1- or 2-cm margins would have similar local recurrence (LR) and overall survival (OS). METHODS: An institutional database was queried for patients with 1.0-2.0 mm melanomas treated from July 1995 to January 2011. All had wide excision and sentinel lymph node biopsy. Patients without documented surgical margins or follow-up were excluded. Clinicopathologic and recurrence data were reviewed. Univariate and multivariate analyses were performed. RESULTS: Of 2,118 patients, 1,225 met study criteria. Of these, 576 had complete data: 224 (38.9%) had 1 cm margins and 352 (61.1%), 2 cm margins. Median follow-up was 38 months. Mean age was 52.6 years (range 11.3-86.7). Mean thickness was 1.27 and 1.48 mm (1 and 2 cm, respectively, p<0.001) with ulceration more common in the 2 cm group (12.3 and 21.3%, respectively; p=0.009). LR was 3.6 and 0.9% in the 1 cm versus 2 cm group, respectively (p=0.044). OS was 29.1 months with 1 cm and 43.7 months in the 2 cm group. On multivariate analysis, only head and neck location and nodal status were associated with overall survival. CONCLUSIONS: In this series, 1 cm margins were associated with a small increase in LR that did not impact OS. This is concordant with the NCCN recommendations; however, a prospective, randomized trial would be optimal.
Subject(s)
Dermatologic Surgical Procedures/methods , Head and Neck Neoplasms/surgery , Melanoma/surgery , Neoplasm Recurrence, Local/etiology , Skin Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Child , Female , Head and Neck Neoplasms/pathology , Humans , Kaplan-Meier Estimate , Lymphatic Metastasis , Male , Melanoma/secondary , Middle Aged , Multivariate Analysis , Proportional Hazards Models , Retrospective Studies , Skin Neoplasms/pathology , Young AdultABSTRACT
The need for useful evidence about services is increasing as larger numbers of children identified with an autism spectrum disorder (ASD) age toward adulthood. The objective of this review was to characterize the topical and methodological aspects of research on services for supporting success in work, education, and social participation among adults with an ASD and to propose recommendations for moving this area of research forward. We reviewed the literature published in English from 2000 to 2010 and found that the evidence base about services for adults with an ASD is underdeveloped and can be considered a field of inquiry that is relatively unformed. Extant research does not reflect the demographic or impairment heterogeneity of the population, the range of services that adults with autism require to function with purposeful lives in the community, and the need for coordination across service systems and sectors. Future studies must examine issues related to cost and efficiency, given the broader sociopolitical and economic context of service provision. Further, future research needs to consider how demographic and impairment heterogeneity have implications for building an evidence base that will have greater external validity.
