Tumor upstaging in invasive melanoma is associated with changes in clinical management and worse prognosis.

Abstract

The clinical implications and prognostic outcomes associated with tumor upstaging in invasive melanoma have not been well established. To determine the frequency of tumor upstaging in invasive melanoma, identify risk factors, and assess its impact on clinical management and outcomes. 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. 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. Single-center retrospective study. Tumor upstaging in invasive melanoma is associated with worse survival outcomes, possibly due to shortfalls in clinical management.