Advertisement

Irish Journal of Medical Science (1971 -)

, Volume 184, Issue 2, pp 511–515 | Cite as

Malignant melanoma: factors affecting the surgical interval from excision biopsy to definitive surgical management

  • M. R. Boland
  • R. S. Prichard
  • G. A. Bass
  • Z. Al-Hilli
  • A. Levendale
  • D. Gibbons
  • K. Sheahan
  • B. Kirby
  • E. W. McDermott
  • D. Evoy
Original Article

Abstract

Introduction

Surgery remains the mainstay of treatment for malignant melanoma. Despite previous studies examining the surgical interval (SI) between the diagnostic excision biopsy (DEB) and definitive surgical management there remains few guidelines regarding an optimal time interval. The aim of this study was to determine the SI between DEB and definitive surgery and elucidate factors associated with delays in management of malignant melanoma.

Methods

A retrospective study of 107 consecutive patients who had a DEB and subsequent wide local excision between January 2011 and June 2012 was performed. Mode of referral and dates of diagnostic biopsy/definitive surgery were documented. Patient demographics and tumour characteristics were reviewed.

Results

The mean age was 59.6 years, and male:female ratio was 1:1.3. Median duration of the SI was 41 ± 27 days (range 6–137 days). The SI was increased when dermatologists performed the DEB as opposed to general surgeons (p = 0.035). The anatomic location of the lesion predicted the SI, with lesions of the head/neck undergoing definitive excision 48 ± 32.3 days after DEB vs. 37.5 ± 22.6 days for all other sites (p = 0.001). Neither demographic factors nor histopathological prognostic features affected the SI. Reasons for a prolonged SI included referrals to different services and time for pre-operative planning.

Conclusions

Significant variations were noted in the SI predominantly accounted for by mode of referral and location of the malignant melanoma. Further investigation is required to elucidate factors affecting the SI and its subsequent effect on patient outcomes.

Keywords

Melanoma Surgery Diagnosis Biopsy Excision Interval 

Notes

Acknowledgments

This article received no funding.

References

  1. 1.
    National Cancer Registry Ireland (2011) Cancer Trends No. 7—Melanoma of Skin. http://www.ncri.ie/pubs/pubfiles/melanoma%20trends.pdf
  2. 2.
    Handley WS (1907) The pathology of melanotic growths in relation to their operative treatment. Lancet; i: 927–33, 996–1003Google Scholar
  3. 3.
    Kelly JW, Sagebiel RW, Calderon W et al (1984) The frequency of local recurrence and microsatellites as a guide to re-excision margins for cutaneous malignant melanoma. Ann Surg 200:759–763PubMedCentralPubMedGoogle Scholar
  4. 4.
    MCKenna DB, Lee RJ, Prescott RJ, Doherty VR (2012) The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival. Br J Dermatol 147:48–54CrossRefGoogle Scholar
  5. 5.
    Carpenter S, Pockaj B, Dueck A et al (2008) Factors influencing time between biopsy and definitive surgery for malignant melanoma: do they impact clinical outcome? Am J Surg 196:834–843CrossRefPubMedGoogle Scholar
  6. 6.
    Parrett BM, Accortt NA, Li R et al (2012) The effect of delay time between primary melanoma biopsy and sentinel lymph node dissection on sentinel node status, recurrence, and survival. Melanoma Res 22(5):386–391CrossRefPubMedGoogle Scholar
  7. 7.
    Garbe C, Peris K, Hauschild A et al; European Dermatology Forum; European Association of Dermato-Oncology; European Organization of Research and Treatment of Cancer (2012) Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline—Update 2012. Eur J Cancer 48(15):2375–2390Google Scholar
  8. 8.
    World Health Organization Mortality Database. May 2013. http://www.who.int/healthinfo/statistics/mortality_rawdata/en/index.html
  9. 9.
    Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F, Capocaccia R; EUROCARE Working Group (2009) EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary. Eur J Cancer 45(6):931–991Google Scholar
  10. 10.
    Al-Hilli Z, Evoy D, Geraghty JG, McDermott EW, Prichard RS Surgery and the staging of Melanoma, Melanoma—from early detection to treatment. In: Dr. Duc Ht (Ed.), ISBN: 978-953-51-0961-7, InTech, doi: 10.5772/53626. Available from: http://www.intechopen.com/books/melanoma-from-early-detection-to-treatment/surgery-and-the-staging-of-melanoma
  11. 11.
    Marsden JR, Newton-Bishop JA, Burrows L et al (2010) Revised UK guidelines for the management of cutaneous melanoma. Br J Dermatol 163:238–256CrossRefPubMedGoogle Scholar
  12. 12.
    Coit DG, Andtbacka R, Anker CJ et al; National Comprehensive Cancer Network (NCCN) (2013) Melanoma, version 2.2013: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw 11(4):395–407Google Scholar
  13. 13.
    Balch CM, Buzaid AC, Atkins MB et al (2000) A new AJCC staging system for cutaneous melanoma. Cancer 88:1484–1491CrossRefPubMedGoogle Scholar
  14. 14.
    Balch C, Soong S, Gershenwald J et al (2001) Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer Melanoma staging system. J Clin Oncol 19:3622–3634PubMedGoogle Scholar
  15. 15.
    Austin PF, Cruse CW, Lyman G et al (1994) Age as a prognostic factor in the malignant melanoma population. Ann Surg Oncol 1:487–494CrossRefPubMedGoogle Scholar
  16. 16.
    McKenna DB, Marioni JC, Lee RJ, Prescott RJ, Doherty VR (2004) A comparison of dermatologists’, surgeons’ and general practitioners’ surgical management of cutaneous melanoma. Br J Dermatol 151:636–644CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  • M. R. Boland
    • 1
  • R. S. Prichard
    • 1
  • G. A. Bass
    • 1
  • Z. Al-Hilli
    • 1
  • A. Levendale
    • 1
  • D. Gibbons
    • 2
  • K. Sheahan
    • 2
  • B. Kirby
    • 3
  • E. W. McDermott
    • 1
  • D. Evoy
    • 1
  1. 1.Departments of General SurgerySt Vincent’s Healthcare GroupDublin 4Ireland
  2. 2.Departments of PathologySt Vincent’s Healthcare GroupDublin 4Ireland
  3. 3.Departments of DermatologySt Vincent’s Healthcare GroupDublin 4Ireland

Personalised recommendations