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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03860883
Registration number
NCT03860883
Ethics application status
Date submitted
7/02/2019
Date registered
4/03/2019
Titles & IDs
Public title
Melanoma Margins Trial-II: 1cm v 2cm Wide Surgical Excision Margins for AJCC Stage II Primary Cutaneous Melanoma
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Scientific title
Melanoma Margins Trial-II - A Phase III, Multi-centre Randomised Controlled Trial Investigating 1cm v 2cm Wide Surgical Excision Margins for AJCC Stage II Primary Cutaneous Melanoma (02.18 MelMarT-II)
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Secondary ID [1]
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02.18
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Universal Trial Number (UTN)
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Trial acronym
MelMarT-II
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cutaneous Melanoma, Stage II
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Condition category
Condition code
Cancer
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Malignant melanoma
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Cancer
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Non melanoma skin cancer
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Surgery - Wide Local Excision = 1cm Margin
Treatment: Surgery - Wide Local Excision = 2cm Margin
Experimental: Arm A (Wide Local Excision = 1cm Margin) - 1cm Wide Local Excision margin + Sentinel Lymph Node Biopsy +/- Reconstruction
Active comparator: Arm B (Wide Local Excision = 2cm Margin) - 2 cm Wide Local Excision margin + Sentinel Lymph Node Biopsy +/- Reconstruction
Treatment: Surgery: Wide Local Excision = 1cm Margin
A wide local excision involves removing an extra "safety margin" of skin surrounding the original melanoma site, to ensure that any remaining scattered melanoma tumour cells that may have been left behind after the first initial biopsy/surgery are removed.
Treatment: Surgery: Wide Local Excision = 2cm Margin
A wide local excision involves removing an extra "safety margin" of skin surrounding the original melanoma site, to ensure that any remaining scattered melanoma tumour cells that may have been left behind after the first initial biopsy/surgery are removed.
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Intervention code [1]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Disease-Free Survival
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Assessment method [1]
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Time from randomisation to clinically, histologically or radiologically confirmed recurrence of melanoma
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Timepoint [1]
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0-60 months
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Secondary outcome [1]
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Local Recurrence
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Assessment method [1]
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Time from randomisation to any clinically, histologically or radiologically confirmed local recurrence of melanoma including satellite lesions and in transit metastases to regional draining lymph nodes
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Timepoint [1]
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Day 0-Trial Completion (max. 120 months)
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Secondary outcome [2]
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Distant Disease-Free Survival
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Assessment method [2]
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Time from randomisation to any clinically, histologically or radiologically confirmed distant recurrence of melanoma
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Timepoint [2]
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Day 0-Trial Completion (max. 120 months)
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Secondary outcome [3]
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Melanoma-Specific Survival
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Assessment method [3]
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Time from randomisation to death due to melanoma
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Timepoint [3]
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Day 0-Trial Completion (max. 120 months)
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Secondary outcome [4]
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Overall Survival
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Assessment method [4]
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Time from randomisation to death from any cause
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Timepoint [4]
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Day 0-Trial Completion (max. 120 months)
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Secondary outcome [5]
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Melanoma-specific Quality of Life: FACT-M questionnaire
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Assessment method [5]
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Measured by FACT-M (Functional Assessment of Cancer Therapy - Melanoma) questionnaire - It consists of two subsections: The FACT-G subsection is a 27-item compilation of general questions divided into four primary QOL domains: Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, and Functional Well-Being. It is considered appropriate for use with patients with any form of cancer. The Melanoma Surgery Subscale evaluates melanoma-specific symptoms such as surgical morbidity and side effects.
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Timepoint [5]
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Baseline, 3, 6, 12 & 24 months
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Secondary outcome [6]
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Neuropathic Pain: PainDetect questionnaire
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Assessment method [6]
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Measured by PainDetect questionnaire
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Timepoint [6]
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Baseline, 3, 6, 12 & 24 months
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Secondary outcome [7]
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Health-related Quality of Life: EQ-5D-5L questionnaire
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Assessment method [7]
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Measured by EuroQoL EQ-5D-5L questionnaire - This tool contains 5 domains including mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
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Timepoint [7]
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Baseline, 3, 6, 12 & 24 months
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Secondary outcome [8]
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Surgery Related Adverse Events
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Assessment method [8]
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The following surgical adverse events will be recorded from the time of surgery to 90 days following surgery (inclusive):
* wound dehiscence
* seroma/haematoma
* haemorrhage
* infection
* skin graft failure
* necrosis of flap used for reconstruction
* deep venous thrombosis
* urinary tract infection
* pneumonia
* cardiac complications
* lymphoedema
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Timepoint [8]
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Up to 90 days from the date of surgery
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Secondary outcome [9]
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Adverse Events
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Assessment method [9]
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An Adverse Event (AE) is any untoward medical occurrence in a participant administered a treatment which does not necessarily have a causal relationship with the treatment. An AE can therefore be any unfavourable or unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the treatment timing, whether or not considered related to the treatment. An AE is any adverse change (developing or worsening) from the participant's pre-treatment condition, including intercurrent illness.
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Timepoint [9]
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Within 1 year from randomisation
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Secondary outcome [10]
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Health Economic Evaluation
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Assessment method [10]
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Data collected for economic analysis will be from hospital notes, MBS and PBS data (Australia) and patient reported outcome measures (including an employment questionnaire) at baseline, 3, 6, 12 and 24 months and at melanoma recurrence.
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Timepoint [10]
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Baseline, 3, 6, 12 & 24 months
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Eligibility
Key inclusion criteria
1. Patients must have a stage II primary invasive cutaneous melanoma with Breslow thickness >2mm without ulceration), or >1mm (with ulceration only) (pT2b-pT4b, AJCC 8th edition) as determined by diagnostic biopsy (narrow excision, incision or punch biopsy) and subsequent histopathological analysis.
2. Must have a primary melanoma that is cutaneous (including head, neck, trunk, extremity, scalp, palm or sole).
3. An uninterrupted 2cm margin must be technically feasible around biopsy scar or primary melanoma.
4. Surgery (which refers to the staging sentinel node biopsy and wide local excision as these are both to be done on the same day) must be completed within 120 days of the original diagnosis.
5. Patients must be 18 years or older at time of consent.
6. Patient must be able to give informed consent and comply with the treatment protocol and follow-up plan.
7. Life expectancy of at least 5 years from the time of diagnosis, not considering the melanoma in question, as determined by the PI.
8. Patients must have an ECOG performance score between 0 and 1.
9. A survivor of prior cancer is eligible provided that ALL of the following criteria are met and documented:
* The patient has undergone potentially curative therapy for all prior malignancies,
* There has been no evidence of recurrence of any prior malignancies for at least FIVE years (except for successfully treated cervical or non-melanoma skin cancer with no evidence of recurrence), and
* The patient is deemed by their treating physician to be at low risk of recurrence from previous malignancies.
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Minimum age
18
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Patients will be excluded from the study for ANY of the following reasons:
1. Uncertain diagnosis of melanoma i.e. so-called 'melanocytic lesion of unknown malignant potential'.
2. Patient has already undergone wide local excision at the site of the primary index lesion.
3. Patient unable or ineligible to undergo staging sentinel lymph node biopsy of the primary index lesion.
4. Desmoplastic or neurotropic melanoma: with any patient where pathology determines melanoma as PURE desmoplastic (as per WHO definition of >90% desmoplasia), they are not eligible for this study. However other desmoplasia or mixed subtypes are eligible unless there is neurotropism present (peri-neural invasion).Peri-neural invasion does not include entrapment of nerves within the main primary tumour mass. Microsatellitosis as per AJCC 8th edition definition
5. Subungual melanoma
6. Patient has already undergone a local flap reconstruction of the defect after excision of the primary and determination of an accurate excision margin is impossible.
7. History of previous or concurrent (i.e., second primary) invasive melanoma.
8. Melanoma located distal to the metacarpophalangeal joint; on the tip of the nose; the eyelids or on the ear; genitalia, perineum or anus; mucous membranes or internal viscera.
9. Physical, clinical, radiographic or pathologic evidence of satellite, in-transit, regional, or distant metastatic melanoma.
10. Patient has undergone surgery on a separate occasion to clear the lymph nodes of the probable draining lymphatic field, including sentinel lymph node biopsy, of the index melanoma.
11. Any additional solid tumour or hematologic malignancy during the past 5 years except T1 skin lesions of squamous cell carcinoma, basal cell carcinoma, or uterine/cervical cancer.
12. Melanoma-related operative procedures not corresponding to criteria described in the protocol.
13. Planned adjuvant radiotherapy to the primary melanoma site after Wide Local Excision is not permitted as part of the protocol and any patients given this treatment would be excluded from the study.
14. History of organ transplantation.
15. Oral or parenteral immunosuppressive agents (not topical or inhaled steroids) at enrolment or within 6 months prior to enrolment.
Pregnancy is not a specific exclusion criterion for this trial, though it may not be clinically appropriate to perform a wide excision and sentinel node biopsy until the pregnancy has been completed, which is likely to exclude the patient due to violation of inclusion criterion 4. We would advise careful counselling of the patient prior to enrolling the patient, which would include a discussion at the treating centre's multidisciplinary team meeting or tumour board. We would strongly advise contacting the central trial office to discuss the case prior to enrolling on the study.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
17/12/2019
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
31/12/2034
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Actual
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Sample size
Target
2998
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
ACT,NSW,QLD,SA,VIC
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Recruitment hospital [1]
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Calvary Public Hospital Bruce - Bruce
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The Canberra Hospital - Garran
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Westmead Hospital - Sydney
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Melanoma Institute Australia - Sydney
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Royal Prince Alfred Hospital - Sydney
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Princess Alexandra Hospital - Brisbane
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Robina Hospital - Gold Coast
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Royal Adelaide Hospital - Adelaide
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Peter MacCallum Cancer Centre - Melbourne
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The Alfred Hospital - Melbourne
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2617 - Bruce
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2605 - Garran
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2145 - Sydney
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- Sydney
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4102 - Brisbane
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4226 - Gold Coast
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5000 - Adelaide
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- Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
Melanoma and Skin Cancer Trials Limited
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Other collaborator category [1]
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Other
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Name [1]
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Norfolk and Norwich University Hospitals NHS Foundation Trust
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Canadian Cancer Trials Group
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Cancer Trials Ireland
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Zuyderland Medical Centre
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Ethics approval
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Summary
Brief summary
Patients with a primary invasive melanoma are recommended to undergo excision of the primary lesion with a wide margin. There is evidence that less radical margins of excision may be just as safe. This is a randomised controlled trial of 1 cm versus 2 cm margin of excision of the primary lesion for adult patients with stage II primary invasive cutaneous melanomas (AJCC 8th edition) to determine differences in disease-free survival. A reduction in margins is expected to improve patient quality of life.
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Trial website
https://clinicaltrials.gov/study/NCT03860883
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Michael Henderson
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Address
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Peter MacCallum Cancer Centre, Australia
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Email
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Contact person for public queries
Name
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Melanoma and Skin Cancer Trials Coordinator
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Address
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Phone
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+61 3 9903 9022
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03860883