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Is Tumor Upstaging Associated With Worse Prognosis in Invasive Melanoma?

By: Chris Schimpf, MSW
Posted: Monday, February 3, 2025

Tumor upstaging in invasive melanoma may be associated with worse survival outcomes, according to research published in the Journal of the American Academy of Dermatology. Amanda Rosenthal, MD, of Kaiser Permanente Los Angeles Medical Center, California, and colleagues suggested this could be attributable to shortfalls in clinical management, and they stressed the importance of adequate initial biopsies of lesions deemed suspicious for melanoma. In cases where adequate biopsy is unachievable, the researchers recommended counseling high-risk patients about the possible need for further surgical or medical management at the time of initial surgical excision. The researchers stressed the need for future studies to validate their findings.

“Our study highlights the significant clinical and prognostic implications of melanoma upstaging, particularly as it relates to surgical management, postoperative care, and patient outcomes,” the investigators stated. “We hope the present analysis informs practicing dermatologists’ counseling, approach, and management of pigmented lesions suspicious for melanoma.”

A total of 4,391 cases of invasive melanoma were included in the single-center, retrospective study, drawn from the Kaiser Permanente Southern California Cancer Registry between 2014 and 2018. Of that total, 9.4% were upstaged. On univariate analysis, the researchers reported that significant risk factors 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. On multivariate analysis, head/neck location and higher pathologic T stage were found to be significant risk factors.

The investigators reported that tumor upstaging dictated a change in clinical management in over half of cases, but that only 37.4% fulfilled the recommendation for additional treatment. Compared with nonupstaged tumors, upstaged melanomas were linked to higher overall (36.0% vs 19.5%; P < .001) and melanoma-specific (9.0% vs 2.9%; P < .001) mortality.

Disclosure: The study authors reported no conflicts of interest.


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