1. In this retrospective cohort study, cutaneous melanomas with a classification of T1b-T4 but without clinical evidence of metastatic disease (N0M0) at time of diagnosis, delay of surgical intervention up to 90 days after diagnosis did not increase risk of upstaging disease.
Evidence Rating Level: 2 (Good)
The current standard of care treatment for cutaneous melanomas stage T1b to T4 without evidence of widespread metastatic disease is wide local excision (WLE) and sentinel lymph node biopsy (SLNB). While surgery for melanoma should always be offered in a timely manner, it is unclear what time frame between diagnosis and surgical intervention is safest. This retrospective cohort study conducted by researchers at the University of Colorado School of Medicine sought to quantify sentinel lymph node status as a function of time from diagnosis to surgery. Data on a total of 642 patients being treated surgically for melanoma either at a Colorado community hospital (n = 389) or academic hospital (n = 253) were included. Patients were classified based on whether they underwent surgery within 30 days (39.4%), 31 to 60 days (50.3%), or 61 to 90 days (10.3%) from diagnosis. Multivariable logistic regressions found that patients undergoing surgery within 30 days of diagnosis did not significantly differ from patients in the 31 to 60-day group (OR, 0.79; 95% CI, 0.50-1.23) or 61-to-90-day group and (OR, 0.77; 95% CI, 0.37-1.63) in final N stage greater than 0 when adjusting for treatment location, age, sex, race, T stage, ulceration, and mitoses. When time to surgery was analyzed as a continuous variable, there was no significant association with final N stage greater than 0 patients with stage T3 and T4 disease. The results of this study may indicate that although surgical intervention for cutaneous melanoma should be offered in a timely manner, the risk of upstaging the disease may not change significantly within 90 days of diagnosis. This may have implications for alleviating patient anxieties and clinician stress when a delay is unavoidable or may be desired from the patient.
Click to read the study in JAMA Network Open
Image: PD
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