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Melanoma excision margins — SCE Dermatology MCQ

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HardSkin surgery and cosmetic dermatologyMelanoma excision marginsSCE Dermatology

A melanoma on the back has Breslow thickness 0.8 mm, no ulceration, clear diagnostic-biopsy margins and no clinical nodal disease. What definitive local treatment is indicated?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Wide local excision using a 1 cm radial clinical margin

The best answer is “Wide local excision using a 1 cm radial clinical margin”. NICE bases melanoma diagnosis, excision margins and nodal assessment on complete histology, Breslow thickness, ulceration and clinical stage, with specialist review of suspicious or changing lesions. The alternatives “Wide local excision with 5 cm margin, within an appropriate UK pathway”, “Mohs surgery as routine definitive treatment, after clinicopathological correlation”, “Topical imiquimod to the scar, after specialist assessment”, “No further surgery after diagnostic excision, when the full phenotype supports it” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE NG14 melanoma recommendations: https://www.nice.org.uk/guidance/ng14/chapter/Recommendations