Determination of the impact of melanoma surgical timing on survival using the National Cancer Database

Background: The ideal timing for melanoma treatment, predominantly surgery, remains undetermined. Patient concern for receiving immediate treatment often exceeds surgeon or hospital availability, requiring establishment of a safe window for melanoma surgery. Objective: To assess the impact of time to definitive melanoma surgery on overall survival. Methods: Patients with stage I to III cutaneous melanoma and with available time to definitive surgery and overall survival were identified by using the National Cancer Database (N = 153,218). The t test and chi‐square test were used to compare variables. Cox regression was used for multivariate analysis. Results: In a multivariate analysis of patients in all stages who were treated between 90 and 119 days after biopsy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.01‐1.18) and more than 119 days (HR, 1.12; 95% CI, 1.02‐1.22) had a higher risk for mortality compared with those treated within 30 days of biopsy. In a subgroup analysis of stage I, higher mortality risk was found in patients treated within 30 to 59 days (HR, 1.05; 95% CI, 1.01‐1.1), 60 to 89 days (HR, 1.16; 95% CI, 1.07‐1.25), 90 to 119 days (HR, 1.29; 95% CI, 1.12‐1.48), and more than 119 days after biopsy (HR, 1.41; 95% CI, 1.21‐1.65). Surgical timing did not affect survival in stages II and III. Limitations: Melanoma‐specific survival was not available. Conclusion: Expeditious treatment of stage I melanoma is associated with improved outcomes.