Longer surgical interval shortens RFS when residual melanoma is present

Issue: April 10, 2016

NEW YORK — Longer surgical interval following initial biopsy may worsen RFS outcomes in patients with residual melanoma, according to a retrospective review presented at HemOnc Today Melanoma and Cutaneous Malignancies.

Surgical interval, defined as the time from initial biopsy to definitive excision, does not appear to affect outcomes for patients with melanoma; however, the impact of prolonged surgical interval when residual melanoma is present after initial biopsy is unknown.

Ashlie Nadler, MD, a surgical oncology fellow at Fox Chase Cancer Center, and colleagues reviewed data from 179 patients (median age, 61 years; 51% male) treated for nonmetastatic cutaneous melanoma to assess how surgical intervention in combination with presence of residual melanoma can affect prognosis.

Ashlie Nadler

The cohort included 108 patients (60%) with shaved biopsies, 25 (14%) with punch biopsies and 46 (26%) with excisional biopsies.

All patients underwent radical excision of the primary lesion and 74% of patients underwent sentinel lymph node biopsy.

Median surgical interval was 41 days (range, 8-1,280) and did not vary by biopsy type.

On final pathology, 81 patients (45%) had residual melanoma. Residual melanoma appeared more common among those who underwent punch biopsy (76%) than shave biopsy (43%) or excisional biopsy (35%; P = .003).

Breslow depth did not significantly affect incidence of residual melanoma.

Median follow-up was 12.4 months (range, 0.2-35.7). During that time, 13 patients developed recurrence or died.

Patients with shorter surgical intervals — defined as 41 days or less — achieved significantly longer RFS than those with longer surgical intervals (P = .035).

A greater proportion of patients with shorter surgical intervals achieved 12-month RFS (97.3% vs. 89.7%), 24-month RFS (94.4% vs. 83.5%), 12-month OS (98.7% vs. 94.7%) and 24-month OS (95.6% vs. 82.2%). These differences in OS reached borderline significance.

Researchers reported no significant difference in RFS or OS based on residual melanoma status.

However, patients with residual melanoma and a longer surgical interval demonstrated the lowest rate of 12-month RFS compared with patients in all other groups combined (81% vs. 92.9%).

Multivariate analysis adjusted for age, disease stage and Breslow depth showed patients with residual melanoma and longer surgical interval experienced shorter RFS (HR = 2.99; 95% CI, 0.9-9.98).

“Longer surgical interval, especially in combination with the presence of residual melanoma following initial biopsy, is associated with worse RFS,” Nadler and colleagues wrote. “Patients anticipated to have residual melanoma should be triaged appropriately to avoid delays to definitive excision.” – by Kristie L. Kahl

Reference: Nadler A, et al. Impact of time from initial biopsy to definitive excision when residual melanoma is present. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 18-19, 2016; New York.

Disclosure: HemOnc Today was unable to confirm the researchers’ relevant financial disclosures at the time of reporting.