Surgical Treatments for Advanced Cutaneous Melanoma

Abstract

For patients who were first discovered and initially diagnosed with advanced melanoma, it is worthwhile to consider whether primary site surgery (PSS) and sentinel lymph node biopsy (SLNB) can also improve the prognosis of patients. This study aimed to assess the effect of PSS and SLNB on the prognosis of patients with advanced melanoma at first diagnosis and to evaluate whether both can improve the overall survival of patients. The survival and disease information of patients with advanced cutaneous melanoma were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards regression was performed to identify risk factors for overall survival (OS) and melanoma-specific survival (MSS). To reduce the possibility of bias, 1:1 propensity score matching (PSM) was used to match age, race, marital status, sex, and tumor size to AJCC stage III and IV patients. A total of 918 patients were included in the study, of which the most were white, accounting for 94.9%, and the average age was 63.9 years. There were 311 females (33.9%) and 607 males (66.1%). Most of the patients with metastasis were gathered in the nonsurgical intervention group, and a few were in the PSS group. Patients with stage III who underwent “SLNB + PSS” (HR = 0.316, 95% CI 0.038–0.801, P = 0.009), PSS (HR = 0.511, 95% CI 0.323–0.874, P = 0.013), and lymphadenectomy (HR = 0.240, 95% CI 0.009–0.853, P = 0.027) had significantly reduced risk of melanoma-specific survival. In stage IV patients, PSS significantly improved patients’ OS (HR = 0.589, 95% CI 0.351–0.987, P = 0.045) and MSS (HR = 0.507 95% CI 0.321–0.849, P = 0.025). “SLNB + PSS” significantly improved OS (HR = 0.877, 95% CI 0.414–0.935, P = 0.043) and MSS (HR = 0.717 95% CI 0.315–0.854, P = 0.019) in patients. For patients with advanced melanoma on first diagnosis, sentinel lymph node biopsy and primary site surgery can still improve patient survival.