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Faster treatment initiation for melanoma linked to better chance of survival

Melanoma patients treated sooner after diagnosis have an increased survival rate, especially those with stage one skin cancer, according to a study based in Cleveland that was published in the Journal of the American Academy of Dermatology (Jan. 2018; 78(1):40–46).

Using the National Cancer Database in the United States, the researchers analyzed 153,218 adult patients diagnosed with stage one to three melanoma from 2004 to 2012. They discovered that overall survival decreased in patients waiting longer than 90 days for surgical treatment, regardless of stage. The delay of surgery beyond the first 29 days also negatively impacted overall survival for stage one melanoma, though not for stage two or three.

Before the analysis, there was no official recommendation on time to treat melanoma, although many physicians often aim to treat melanoma surgically three to four weeks after diagnosis.

“The ideal timing for melanoma treatment, predominantly surgery, had yet to be determined—until now,” said Dr. Brian Gastman, lead study author and surgical director for the melanoma and high risk skin cancer program at the Cleveland Clinic, in a press release. “Patients and referring physicians are not only concerned with how a melanoma is removed, but also when it’s removed. We saw significantly worse prognoses and outcomes for those surgically treated after 30 days of stage one melanoma diagnosis. Knowing for certain that a more expedient time to surgery to remove an early melanoma improves the chances of survival is a game-changer in treating this life-threatening skin cancer.”

Compared to patients who were treated within 30 days, 5% of patients with stage one melanoma had a mortality risk when treated between 30 and 59 days; 16% had a mortality risk when treated between 60 and 89 days; 29% had a mortality risk when treated between 91 and 120 days; and 41% had a mortality risk when treated after 120 days.

Furthermore, patients with delayed treatment commencement tended to be older and male, and have more comorbidities.

It is also likely that more advanced cases represent delays in diagnosis, and these delays overwhelm the impact of a faster treatment.

The study concluded, however, that in early stage cases, early diagnosis allows for the opportunity to improve the chances of survival with a prompt surgery.

Dr. Brian Gastman. Photo courtesy of the Cleveland Clinic.

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