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Risk factors identified for tumor upstaging of melanoma

Anatomic location and subtotal diagnostic biopsies were the greatest risk factor for upstaging of melanoma, according to recently published study results in the Journal of the American Academy of Dermatology.

“When residual melanoma remains after the diagnostic biopsy, upstaging (defined as an increase in the T stage designated by the American Joint Committee on Cancer) might be detected after wide local excision in 5% to 22% of cases,” researchers at the University of Pennsylvania, wrote. “Upstaging might complicate patients counseling about prognosis and surgical management of melanoma.”

The researchers conducted a retrospective cross-sectional study of patients (mean age, 60.8; 57.6% men) with 1,332 consecutive in situ to T4a biopsy-proven melanomas treated with wide local excision.

Overall, the rate of melanoma upstaging was 3.9%, and 11.3% among lesions with residual microscopic melanoma in the wide local excision specimen.

Anatomic location on the head, neck, hands, feet, genital or pretibial leg (OR = 7.06; 95% CI, 3.77-13.25) was the greatest risk factor for upstaging, according to multivariate analysis. Other risk factors included extension of the melanoma to the base of the biopsy specimen (P < .001), multiple preoperative diagnostic biopsies (OR = 1.89; 95% CI, 1.23-2.93), increasing patient age (OR = 1.03; 95% CI, 1.01-1.06) and nonlentigo histopathologic subtype (P = .002).

The hands and feet, and head and neck showed raw frequencies for upstaging of 12% each.

“Identifying patients at high risk for upstaging is important to improve preoperative counseling about prognosis and surgical management,” the researchers concluded. “Patients with melanomas at high risk for upstaging might benefit from preoperative counseling that prognosis and surgical management might change after complete microscopic tumor staging.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.