Melanoma
.jpeg.jpg "Ned Farley, MD photo")
Ned Farley, MD
Medical
Melanoma Institute, The University of Sydney, Sydney, NSW
Newcastle, New South Wales, Australia
Jake Hindmarch, MD, MD
Doctor
Melanoma Instititute, United States
Jake Hindmarch, MD, MD
Doctor
Melanoma Instititute, United States
Janet McKeown, PhD
Statitician
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
Serigne N. Lo, PhD
Biostatistician
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
Sydney Ch'ng, MBBS, PhD, FRACS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
North Sydney, New South Wales, United States
Omgo Nieweg, MD, PhD
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
Thomas Pennington, MBBS, FRACS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
Kerwin Shannon, MBBS, FRACS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
Andrew Spillane, MBBS, MD, FRACS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, Australia
Johnathon Stretch, D.Phil, MD, FRACS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
John Thompson, MBBS, MD, DSc, FRACS, FACS (Hon), FAHMS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
North Sydney, New South Wales, Australia
Robyn Saw, MBBS, FRACS, MS
Surgeon
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia, United States
It is widely accepted that definitive surgical treatment for primary cutaneous melanoma should occur promptly, but the effects of a delay between initial diagnosis and definitive surgery remain unclear. In addition, a lack of high quality evidence exists for an optimal time-to-surgery from initial melanoma diagnosis. The aim of this study was to determine whether survival was impacted by the timing of surgical treatment and whether there was an optimal time interval between melanoma diagnosis and definitive surgical treatment with respect to survival outcomes.
This was a retrospective cohort study of primary cutaneous primary melanoma patients treated at a single institution between 1990 and 2015. The association between time-to-surgery and clinical outcomes including overall survival (OS), melanoma-specific survival (MSS) and recurrence-free survival (RFS) was described using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to quantify the relationship between each time-to-surgery cohort and each clinical outcome.
Methods:
Results:
In total, 18245 patients were included in the analysis. Time to surgery was divided into £ 1 week, 1-4 weeks, 4-8 weeks, 8-12 weeks and >12 weeks (n= 2453, 8881, 5904, 871 and 126 respectively). The average patient age was 57.0 years and 57% were male. The majority of primary melanomas were located on the trunk (33%) and upper limb (25%). Median Breslow thickness was 1.1mm (mean 1.8mm, range 0.1-47mm) and 64% were of superficial spreading subtype. Increasing time delay of definitive surgical treatment seemed to be associated with poorer OS and RFS. A time of 1-4 weeks between initial diagnosis of primary cutaneous melanoma and definitive surgery appeared to be associated with better OS and RFS. (see Fig 1 for OS)
Time to surgery, age at primary melanoma diagnosis, gender, site of primary melanoma, melanoma subtype, ulceration status, and mitotic rate were independent factors significantly associated with OS and RFS on multivariable analysis (p< 0.001).
Conclusions:
Definitive surgical treatment of primary cutaneous melanoma at 1-4 weeks post diagnosis was associated with improved OS & RFS in this large group of patients treated before the introduction of effective drug therapy.