Statistically significant increases in overall mortality & melanoma-specific mortality among delayed wide local excision as early as one month in patients with stage I melanoma (P = 0.001)
Clinical Pearls
Statistically significant increases in overall mortality & melanoma-specific mortality among delayed wide local excision as early as one month in patients with stage I melanoma (P = 0.001)
Delay in resection of stage II melanoma additionally was found to have statistically significant increases in overall mortality & melanoma-specific mortality, however only at delays of 3-5 months (HR 1.36, 95% CI 1.12-1.65; P = 0.009)
Delayed surgical resection of stage III melanoma had no effect on overall mortality or melanoma-specific mortality, suggesting
Discussion:
Cutaneous melanoma is among the most frequently diagnosed malignancies in the United States, with a rising incidence in older individuals as well as carrying large burden of mortality. Prior data, both from a Scottish cohort as well as through an analysis of National Cancer Database, did not find any changes in mortality secondary to delays in wide local excisions, particularly among stage II & III melanomas.
This study sought to identify if treatment delay, namely surgical excision, has any effect on melanoma-specific mortality (MSM), something that has not previously been identified, as well as overall mortality. Using de-identified patient data from the Surveillance, Epidemiology, and End Results (SEER) program, which captured data from 2010 to 2016, this retrospective cohort study included a total of 108,689 patients with melanoma at stages I-III. Overall adjusted hazard ratios for all-cause mortality across all stages significantly increased with both 1-2 month treatment delay (HR 1.09; 95% CI 1.04-1.14, P = 0.001) as well as delay of 3-5 months (HR 1.5; 95% CI, 1.33-1.68; P <0.001). However, upon further stratified analysis of overall mortality, it was found that delays in surgical excision as small as 1-2 months only significantly affected patients at stage I melanoma (HR 1.09, 95% CI 1.02-1.17, P = 0.03). Patients at stage II only demonstrated significant difference in overall mortality at 3-5 months (HR 1.36; 95% CI 1.12-1.65; P = 0.009), while patients diagnosed with stage III melanoma demonstrated no significant difference among overall mortality with any length of delay in excision. When melanoma-specific mortality was analyzed for the patient cohort overall, it was found that MSM was significantly increased with any treatment delay.
When performing stratified analysis, stage I patients demonstrated significant increases in MSM at 1-2 month (HR 1.36, 95% CI 1.15-1.6, P = 0.0003), 2-3 month, and 3-5 month treatment delays, whereas stage II patients only demonstrated a significant increase in MSM at 6+ months (HR 3.669, CI 1.95-6.9, P <0.0001). Finally, patients with stage III melanoma only demonstrated a significant increase in MSM at 1-3 month delays (1-2 months: HR 1.16, 95% CI 1.038-1.311, P = 0.01; 2-3 months: HR 1.27, CI 95% CI 1.065-1.514, P 0.008). Such results suggest that prompt treatment, particularly at earlier stages of melanoma, may have both an overall mortality as well as disease-specific mortality benefit. However, limitations of this study are its inherent retrospective nature, as well as incomplete treatment data about use of adjuvant therapies, which may partially explain lack of significant differences in both overall mortality & melanoma-specific mortality among patients with stage III melanoma.
Comments