Original articleDetermination of the impact of melanoma surgical timing on survival using the National Cancer Database
Section snippets
Methods and materials
The NCDB is a clinical oncology database established in 1989 as a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and American Cancer Society. A business associate agreement, including a data use agreement, between the American College of Surgeons and CoC accredited facilities is in place. The NCDB is a facility-based database, representing 48.4% of all melanomas diagnosed in the United States.14, 15 This database contains cases of patients 18 or older who
Results
We identified 153,218 patients, of whom 71,950 were treated 30 days or more after biopsy. Specifically, 44.9% of stage I melanomas were treated 29 or more days after biopsy, as were 50.3% of stage II and 51.3% of stage III melanomas (Supplemental Fig 1; available at http://www.jaad.org). Furthermore 9% of stage I melanomas were treated 59 or more days after biopsy, as were 11.8% of stage II and 11.7% of stage III melanomas. Patients with a longer TTI tended to be older, be male, be using
Discussion
In this study, we were, to the best of our knowledge, the first to show that OS decreases in patients waiting longer than 90 days for definitive surgical treatment of melanoma regardless of stage. Moreover, we believe that we are reporting for the first time that delay of surgery beyond the first 29 days for stage I melanoma negatively OS when 30-day intervals are used. Furthermore, when TTI was analyzed in 2-week intervals for stage I, we found that the critical time point at which TTI in the
Conclusion
In conclusion, we found that definitive surgical treatment for stage I melanoma should be expeditious, whereas definitive surgical treatment for stage II and III may not affect OS in the current milieu of melanoma. Furthermore, expeditious patient identification and biopsy could migrate would-be stage II and III patients to stage I, where TTI optimization can be used to further improve their OS. On the basis of the available literature combined with our data, it is likely that these times are
References (35)
- et al.
Systematic skin cancer screening in northern Germany
J Am Acad Dermatol
(2012) - et al.
Evidence of increasing mortality with longer diagnostic intervals for five common cancers: a cohort study in primary care
Eur J Cancer
(2013) - et al.
Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline—update 2016
Eur J Cancer
(2016) - et al.
(Neo)adjuvant systemic therapy for melanoma
Eur J Surg Oncol
(2017) - et al.
Adjuvant immunotherapy of melanoma and development of new approaches using the neoadjuvant approach
Clin Dermatol
(2013) - et al.
Cancer statistics, 2016
CA Cancer J Clin
(2016) Cancer Facts & Figures 2016
(2016)- et al.
Emerging trends in the epidemiology of melanoma
Br J Dermatol
(2014) - et al.
Final trial report of sentinel-node biopsy versus nodal observation in melanoma
N Engl J Med
(2014)
Survival impact of increasing time to treatment initiation for patients with head and neck cancer in the United States
J Clin Oncol
Time to surgery and breast cancer survival in the United States
JAMA Oncol
The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival
Br J Dermatol
The relationship between melanoma thickness and time to diagnosis in a large population-based study
Arch Dermatol
Health-care delay in malignant melanoma: various pathways to diagnosis and treatment
Dermatol Res Pract
The National Cancer Data Base: a powerful initiative to improve cancer care in the United States
Ann Surg Oncol
Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review
Br J Cancer
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Funding sources: None.
Conflicts of interest: None declared.
Reprints not available from the authors.