Melanoma Surgery Delay After 4 Weeks Post-Diagnosis Decreases Survival Rates

Delaying definitive melanoma surgery past 4 weeks following a diagnosis is linked with significantly worse overall and recurrence-free survival, new findings suggest.1

In this analysis, optimal outcomes were observed when surgery took place within a 1 - 4 week timeframe. The study resulting in these findings was authored by several investigators, including Robyn Saw, MBBS, of the Melanoma Institute Australia.

Saw et al’s research was conducted with 2 principal aims: One, determining whether surgical treatment timing for Stage I & II melanoma shows a link with survival outcome, and two, finding out if there is an optimal time interval between melanoma diagnosis and surgery that exists related to survival. They described a variety of reasons attributable to surgical delays among patients diagnosed with skin cancer.2

“The primary aim of this study was therefore to assess whether survival was associated with the time between melanoma diagnosis and definitive surgical treatment and to evaluate the optimal time interval between melanoma diagnosis and definitive surgical treatment with respect to survival,” Saw and colleagues expressed.1

Study Design and Findings on Surgery Timing

The investigative team drew the necessary data for their study from the prospectively maintained Melanoma Institute Australia database for individuals given a diagnosis. These were specifically patients with American Joint Committee on Cancer (AJCC) 8th Edition pathological Stage I or II cutaneous melanoma who also presented in the timeframe between 1990 - 2015. They were not included if they had Stage 0 disease (melanoma in situ), if their pathological stage was not reported, or if they were classified as pathological Stage III or IV.

The definition of Saw et al of time to surgery was the interval between one’s initial diagnostic biopsy confirming melanoma and one’s definitive surgical procedure. Such a procedure involved a wide excision with guideline-concordant margins. This interval between skin cancer diagnosis and surgery was categorized into 5 cohorts: those diagnosed within 1 week or less, 1 - 4 weeks, 4 - 8 weeks, 8 - 12 weeks, and more than 12 weeks. The team calculated subjects’ overall survival from the date of their diagnostic biopsy to the date of mortality or last recorded follow-up for those who had not passed away.

The definition of a recurrence-free survival was the time from patients’ biopsy to the initial documented recurrence or last follow-up in the absence of skin cancer recurrence. Outcomes according to surgical timing were assessed by Saw and colleagues via Kaplan–Meier survival estimates. They aimed to add to their analysis through multivariable Cox proportional hazards regression models, applied to estimate hazard ratios (HRs) for patients’ overall survival and recurrence-free survival across the aforementioned time-to-surgery categories.

After evaluating them for inclusion criteria, 18,242 individuals were analyzed. The investigative team noted the mean age of the cohort had been 57.5 years, with men accounting for 57%. The most common location of primary tumors was the trunk, with 32.5% cases in total. This was followed by the upper limbs at 24.7% as the second most frequent area on the body. The average Breslow thickness was determined to be 1.8 mm, with values ranging from 0.1 mm - 50 mm. Superficial spreading melanoma was shown to be the predominant histologic subtype, accounting for 64% of the observed tumors.

Saw and coauthors stratified by time to surgery, noting the following patient decisions on definitive excision:

• 2453 underwent excision within 1 week
• 8882 within 1 - 4 weeks
• 5906 within 4 - 8 weeks
• 870 within 8 - 12 weeks
• 126 after more than 12 weeks

A link was additionally observed between longer delays between one’s diagnosis/definitive surgical management and worse clinical outcomes.

Compared to individuals treated in the 1 - 4 week range, those whose surgery took place between 8 - 12 weeks had poorer overall rates of survival (HR 1.23). A similar pattern was observed for recurrence-free survival (HR 1.36) for the 8- to 12-week cohort relative to the 1 - 4-week cohort, suggesting an increased recurrence risk with prolonged time to surgery.

“Improved data collection, including reasons for treatment delays and patient comorbidities, would assist in determining factors that may be able to be modified to achieve the 4 week timeframe,” Farley and coauthors concluded.1

References

1. Farley EN, Hindmarch J, Saw RPM, et al. Timing of Definitive Surgical Management of Primary Cutaneous Melanoma: Association With Survival. ANZ J Surg. 2026 Jan 14. doi: 10.1111/ans.70490. Epub ahead of print. PMID: 41532394.

2. Baranowski MLH, Yeung H, Goodman M, et al. Factors associated with time to surgery in melanoma: An analysis of the National Cancer Database. J Am Acad Dermatol. 2019 Oct;81(4):908-916. doi: 10.1016/j.jaad.2019.05.079. Epub 2019 Jun 1. PMID: 31163238; PMCID: PMC6752196.