Background: The clinical implications and prognostic outcomes associated with tumor upstaging in invasive melanoma have not been well established.
Objectives: To determine the frequency of tumor upstaging in invasive melanoma, identify risk factors, and assess its impact on clinical management and outcomes.
Methods: A retrospective study using data from a statewide Surveillance Endpoints and End Results-affiliated cancer registry between 2014 and 2018 was performed. Multivariable hazard models were used to determine factors associated with upstaging and overall/melanoma-specific mortality.
Results: Of 4391 cases of invasive melanoma, 9.4% were upstaged. Significant risk factors on univariate analysis included older age, male sex, non-White race, head/neck location, larger clinical size, incisional and/or punch biopsy method, and increasing time between biopsy and surgical excision. Significant risk factors on multivariable analysis included head/neck location and higher pathologic T stage. Tumor upstaging dictated a change in clinical management in over half of cases; however, only 37.4% fulfilled the recommendation for additional treatment. Upstaged melanomas experienced higher overall (36.0% versus 19.5%; P < .001) and melanoma-specific (9.0% versus 2.9%; P < .001) mortality compared to non-upstaged tumors.
Limitations: Single-center retrospective study.
Conclusions: Tumor upstaging in invasive melanoma is associated with worse survival outcomes, possibly due to shortfalls in clinical management.
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| http://dx.doi.org/10.1016/j.jaad.2024.11.028 | DOI Listing |
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