Delay of surgical treatment for melanoma up to 90 days not linked to poorer outcomes

The study is published in JAMA Network Open.

Explaining the study background, researchers said that wide local excision (WLE) and sentinel lymph node biopsy (SLNB) are the standard treatment for patients with stage T1b or higher cutaneous melanoma without radiographic or clinical evidence of metastatic disease. This therapeutic option has immediate purposes like prognostication, staging (identification of occult metastatic disease) and guiding decisions for adjuvant systemic treatment. The area which requires more data and research is the wait time, meaning, "How long can a patient safely wait between diagnosis and surgery before it can affect disease staging?" so we determined if there is a relation between increasing time to surgery and sentinel lymph node status. The study followed STROBE reporting guidelines. We measured sentinel lymph node status as a function of time from diagnosis to surgery as the primary outcome.

The academic and community hospital, including melanoma databases of the University of Colorado Hospital and Northside Hospital, was queried for patients with primary T1b to T4, clinical N0M0 cutaneous melanoma undergone WLE and SLNB (January 2018 - June 2021).

The results of the research are:

• Six hundred forty-two patients of median age 60 years, including 367 men and 624 White patients with a history of melanoma, underwent WLE and SLNB within 90 days of diagnosis.
• Four hundred twelve patients constituting 64.3%, had T1 or T2 stage disease at diagnosis.
• Three hundred eighty-nine patients underwent surgery at the community hospital.
• 39.4% (253 patients) underwent surgery within 30 days of diagnosis.
• Three hundred twenty-three patients, nearly 50.3%, underwent surgery within 31 to 60 days of diagnosis.
• 10.3 %, including 66 patients, underwent surgery within 61 to 90 days of diagnosis.
• The rate of nodal positivity was 20.2%.
• There was no difference in Nodal positivity rates for patients who underwent surgery within 30 days of diagnosis and those within 31 to 60 days or 61 to 90 days of diagnosis.
• There was a significant association between Younger age and a higher T stage with a final N stage greater than 0.

They said the study indicated that odds of sentinel lymph node positivity remained similar over time up to 90 days for those undergoing WLE and SLNB for T1b or higher clinical N0M0 cutaneous melanoma.

Although it is important to perform surgery on time, there is no association between time and change in risk of upstaging disease within 90 days of diagnosis.

This will alleviate the clinician's and the patient's anxiety when a delay is unavoidable.

The study's limitations are its retrospective nature and the number of treatment sites.

Further investigations are warranted for more research.

Further reading:

Le ELH, Lamping E, Helmkamp L, et al. Analysis of Time Between Skin Lesion and Lymph Node Biopsies and Lymph Node Metastasis in Patients With Melanoma. JAMA Netw Open. 2023;6(5):e2311472. doi:10.1001/jamanetworkopen.2023.11472