Tumor Upstaging in Invasive Melanoma is Associated with Changes in Clinical Management and Worse Prognosis

Amanda Rosenthal; Joyce Y Kim; Margit Lw Juhasz; Geena Conde; Clare Chen; Sarah Eng; Cristo A Carrasco Mendoza; Crystal T Chang; Iesha Ticknor; Leandra Doan; Kathyrn B Schwarzmann; Sarah Garzione; Yunjie Li; Zeuz A Islas; Nima M Gharavi; Jeremy R Man

doi:10.1016/j.jaad.2024.11.028

Tumor Upstaging in Invasive Melanoma is Associated with Changes in Clinical Management and Worse Prognosis

J Am Acad Dermatol. 2024 Nov 21:S0190-9622(24)03233-X. doi: 10.1016/j.jaad.2024.11.028. Online ahead of print.

Authors

Affiliations

¹ Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: amanda.x.rosenthal@kp.org.
² Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA.
³ Dermatology of Seattle & Bellevue, Burien, WA.
⁴ University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
⁵ Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA.
⁶ Cedars-Sinai Medical Center, Los Angeles, CA.

PMID: 39579989
DOI: 10.1016/j.jaad.2024.11.028

Abstract

Background: The clinical implications and prognostic outcomes associated with tumor upstaging in invasive melanoma have not been well established.

Objective: 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 4,391 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<0.001) and melanoma-specific (9.0% versus 2.9%; p<0.001) 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.

Keywords: AJCC; American Joint Committee on Cancer; T stage; biopsy; clinical management; clinical outcomes; excision; invasive melanoma; lymph node; melanoma; melanoma in situ; melanoma mortality; mortality; prognosis; re-excision; sentinel lymph node biopsy; surgical management; tumor management; tumor stage; tumor upstaging.