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.
Access this article
We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.
Similar content being viewed by others
References
National Cancer Registry Ireland (2011) Cancer Trends No. 7—Melanoma of Skin. http://www.ncri.ie/pubs/pubfiles/melanoma%20trends.pdf
Handley WS (1907) The pathology of melanotic growths in relation to their operative treatment. Lancet; i: 927–33, 996–1003
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 200:759–763
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 147:48–54
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 196:834–843
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):386–391
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):2375–2390
World Health Organization Mortality Database. May 2013. http://www.who.int/healthinfo/statistics/mortality_rawdata/en/index.html
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):931–991
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
Marsden JR, Newton-Bishop JA, Burrows L et al (2010) Revised UK guidelines for the management of cutaneous melanoma. Br J Dermatol 163:238–256
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):395–407
Balch CM, Buzaid AC, Atkins MB et al (2000) A new AJCC staging system for cutaneous melanoma. Cancer 88:1484–1491
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 19:3622–3634
Austin PF, Cruse CW, Lyman G et al (1994) Age as a prognostic factor in the malignant melanoma population. Ann Surg Oncol 1:487–494
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 151:636–644
Acknowledgments
This article received no funding.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Boland, M.R., Prichard, R.S., Bass, G.A. et al. Malignant melanoma: factors affecting the surgical interval from excision biopsy to definitive surgical management. Ir J Med Sci 184, 511–515 (2015). https://doi.org/10.1007/s11845-014-1157-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-014-1157-5