October 30, 2017

Timing of Melanoma Diagnosis, Treatment Critical to Survival

Prompt treatment especially important for stage I melanoma

Dr.Gastman_650x450

A new Cleveland Clinic study underscores the importance of early detection and treatment of melanoma, the deadliest form of skin cancer. The research, published in the Journal of the American Academy of Dermatology, indicates that the sooner patients were treated, the better their survival, particularly for stage I melanoma.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Using the National Cancer Database, researchers from Cleveland Clinic’s Cancer Center and its Dermatology & Plastic Surgery Institute studied 153,218 adult patients diagnosed with stage I-III melanoma from 2004 to 2012. The investigators found that overall survival (OS) decreased in patients waiting longer than 90 days for surgical treatment, regardless of stage. In addition, the delay of surgery beyond the first 29 days negatively impacted overall survival for stage I melanoma, though not for stage II or III.

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.

Compared to patients who were treated within 30 days, patients with stage I melanoma were:

Advertisement
  • 5 percent more likely to die when treated between 30 and 59 days (95% CI 1.01-1.1; P = 0.029);
  • 16 percent more likely to die when treated between 60 and 89 days (95% CI 1.07-1.25; P > 0.001);
  • 29 percent more likely to die when treated between 91 and 120 days (95% CI 1.12-1.48; P > 0.001); and
  • 41 percent more likely to die when treated after 120 days (95% CI 1.21-1.65; P > 0.001).

Patients with a longer time to treatment initiation tended to be older and male, and have more comorbidities.

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.

According to the authors, it is likely that more advanced cases represent delays in diagnosis, and these delays overwhelm the impact of a speedier treatment. However, in early stage cases, early diagnosis allows for the opportunity to improve the chances of survival with a prompt surgery. Although many physicians treat melanoma surgically three to four weeks after diagnosis, there is no official recommendation on time to treatment.

Advertisement

“The ideal timing for melanoma treatment, predominantly surgery, had yet to be determined – until now,” said Brian Gastman, MD, medical and surgical director of melanoma and high-risk skin cancer program at Cleveland Clinic, and lead author on the study. “Patients and referring physicians are not only concerned with how a melanoma is removed, but also when it’s removed. We saw significantly worse prognoses and outcomes for those surgically treated after 30 days of stage 1 melanoma diagnosis. Knowing for certain that a more expedient time to surgery to remove an early melanoma improves the chances of survival is a game-changer in treating this life-threatening skin cancer.”

Related Articles

Physician with patient
February 21, 2024
Strategies for Improving Clinical Trial Equity

Cleveland Clinic Cancer Institute takes multi-faceted approach to increasing clinical trial access

How antibody drug conjugates work
February 13, 2024
Real-World Use of Trastuzumab Deruxtecan

Key learnings from DESTINY trials

24-CNR-4545611-CQD-Podcast-967×544
February 1, 2024
Possibilities of CRISPR Technology (Podcast)

Gene editing technology offers promise for treating multiple myeloma and other hematologic malignancies, as well as solid tumors

Disparities in multiple myeloma
January 25, 2024
Major Study Identifies Global Disparities in Drug Toxicity for Multiple Myeloma Treatment

Study of 401,576 patients reveals differences in cancer burdens as well as overall survival

Dr. Shilpa Gupta
December 27, 2023
A New Standard Emerges in Advanced Urothelial Carcinoma After Decades of First-Line Chemotherapy

Enfortumab plus pembrolizumab reduced risk of death by 53% compared with platinum-based chemotherapy

23-CNR-4318382-CQD-Hero-650×450 Dr Hill
December 19, 2023
Active Surveillance may be a Feasible Option for a Subset of Patients with Nodular Lymphocyte-Predominant Hodgkin Lymphoma

Large cohort study finds no reduction in survival for patients managed with active surveillance compared to treated patients

Dr. Caimi
December 15, 2023
CAR-T Cell Therapy Effective in Refractory Double-Hit/Triple-Hit Lymphoma

Two thirds of patients responded to CAR T-cell therapy

23-CNR-4344308-CQD-Hero-650×450 Ornstein
December 14, 2023
Belzutifan Shows Improvement in Progression-Free Survival for Patients with Refractory Clear-Cell Kidney Cancer

Belzutifan superior to everolimus in phase 3 clinical trial

Ad