Early Surgical Treatment Best for Melanoma

November 13, 2017

Treatment within 30 days of melanoma diagnosis was associated with improved outcomes; overall survival decreased in patients waiting longer than 90 days for surgery.

Treatment within 30 days of melanoma diagnosis was associated with improved outcomes, according to the results of a study published in the Journal of the American Academy of Dermatology. Overall survival decreased in patients waiting longer than 90 days for surgical treatment, regardless of the stage of disease.

“The ideal timing for melanoma treatment, predominantly surgery, had yet to be determined-until now,” said primary investigator Brian R. Gastman, MD, director of melanoma surgery at Cleveland Clinic. “Patients and referring physicians are not only concerned with how a melanoma is removed, but also when it’s removed. We saw significantly worse prognoses and outcomes for those surgically treated after 30 days of stage I melanoma diagnosis. Knowing for certain that a more expedient time to surgery to remove an early melanoma improves the chances of survival is a game-changer in treating this life-threatening skin cancer.”

The study was designed to assess the impact of time to definitive melanoma surgery on overall survival. It included more than 150,000 patients with stage I to III cutaneous melanoma from the National Cancer Database from 2004 to 2012.

Multivariate analysis showed that compared with surgical treatment within 30 days of biopsy, those patients in all stages treated between 90 and 119 days (hazard ratio [HR], 1.09; 95% CI, 1.01–1.18) and after more than 119 days (HR, 1.12; 95% CI, 1.02–1.22) had a higher mortality risk.

The researchers conducted a subgroup analysis of only those patients with stage I disease and the trend remained with higher mortality risk seen in patients treated within 30 to 59 days (HR, 1.05), 60 to 89 days (HR, 1.16), 90 to 119 days (HR, 1.29), and more than 119 days after biopsy (HR, 1.41). Delay of surgery did not affect survival for patients with stage II or III disease.

“We hypothesize that the negative effect of prolonging time to treatment initiation on early-stage melanoma is visible as a result of the lower baseline mortality found in these patients,” the researchers wrote. “However, in stages II and III, the potential benefits of a shorter time to treatment initiation are likely overshadowed by a higher metastatic potential and baseline mortality. In other words, it appears that prompt initiation of definitive treatment is beneficial in stage I melanoma but likely not in stage II or III.”

Based on these results, the researchers suggested that greater efforts be made to improve the entire process “from suspicion of melanoma to its ultimate treatment.”