Melanoma: How Much Does Time To Treatment Matter?
Ruzica Z. Conic, MD, Claudia Cabrera, MD, Alok Khorana, MD, Brian Gastman, MD.
Cleveland Clinic, Cleveland, OH, USA.
PURPOSE: Melanoma is a worldwide problem that continues to rise. The recommended timing for melanoma treatment is within 3-6 weeks, but no “ideal” time has been determined. We aim to examine survival based on time to definitive melanoma surgery, and factors affecting overall survival.
METHODS: The National Cancer Database (NCDB) was used to identify patients with cutaneous melanoma who were stage I-III, had overall survival and time to definitive surgery that was greater than 0 days but less than 120 (n=151,298). T-test and Chi-square were used to compare variables, and multivariate analysis was performed using Cox proportional hazards model.
RESULTS: Patients with longer times to treat tended to be male, use Medicare, have melanoma on the head and neck and have a higher melanoma stage. Younger age at diagnosis, lack of comorbidities, and lower melanoma stage favorably affected survival. After multivariate adjustment, there was no difference between patients treated in 1-30 days, 31-60 (HR 1.02, 95%CI 0.99-1.04) and 61-90(1.03, 95%CI 0.99-1.08). Patients who were treated between 91-120 days (HR 1.09, 95%CI 1.01-1.18) are 9% more likely to die compared to patients who were treated within 30 days.
CONCLUSION: Currently, there is no evidence to support that time to treatment less than 90 days has an impact on melanoma survival. Most likely the impact of time to detection and biopsy greatly outweigh the impact of time to surgery in the case of melanoma. When caring for these patients, further emphasis should be placed on occurrences prior to melanoma biopsy.
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