Determination of the impact of melanoma surgical timing on survival using the National Cancer Database

Abstract

Background: The ideal timing for melanoma treatment, predominantly surgery, remains undetermined. Patient concern for receiving immediate treatment often exceeds surgeon or hospital availability, requiring establishment of a safe window for melanoma surgery.

Objective: To assess the impact of time to definitive melanoma surgery on overall survival.

Methods: Patients with stage I to III cutaneous melanoma and with available time to definitive surgery and overall survival were identified by using the National Cancer Database (N = 153,218). The t test and chi-square test were used to compare variables. Cox regression was used for multivariate analysis.

Results: In a multivariate analysis of patients in all stages who were treated between 90 and 119 days after biopsy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.01-1.18) and more than 119 days (HR, 1.12; 95% CI, 1.02-1.22) had a higher risk for mortality compared with those treated within 30 days of biopsy. In a subgroup analysis of stage I, higher mortality risk was found in patients treated within 30 to 59 days (HR, 1.05; 95% CI, 1.01-1.1), 60 to 89 days (HR, 1.16; 95% CI, 1.07-1.25), 90 to 119 days (HR, 1.29; 95% CI, 1.12-1.48), and more than 119 days after biopsy (HR, 1.41; 95% CI, 1.21-1.65). Surgical timing did not affect survival in stages II and III.

Limitations: Melanoma-specific survival was not available.

Conclusion: Expeditious treatment of stage I melanoma is associated with improved outcomes.

Keywords: National Cancer Database; melanoma; stage I melanoma; survival; time to surgery; time to treatment.

Fig 1

Flowchart presenting selection of patients from the National Cancer Database.

Fig 2

Graphic representation of adjusted and unadjusted hazard ratios by time to treatment initiation. Point estimates represent hazard ratios. Bars represent 95% confidence intervals. A, Unadjusted hazard ratios by time to treatment initiation. B, Unadjusted hazard ratio for days to treatment in stage I. C, Unadjusted hazard ratio for days to treatment in stage II. D, Unadjusted hazard ratio for days to treatment in stage III. Asterisks denote statistical significance.

Fig 3

Graphic representation of adjusted hazard ratios by time to treatment initiation. Point estimates represent hazard ratios. Bars represent 95% confidence intervals. A, Adjusted hazard ratios by time to treatment initiation. B, Adjusted hazard ratio for days to treatment in stage I. C, Adjusted hazard ratio for days to treatment in stage II. D, Adjusted hazard ratio for days to treatment in stage III. Asterisks denote statistical significance.