A recent study reveals that tumour upstaging in invasive melanoma, a critical escalation in disease severity identified post-diagnosis, occurs in 9.4% of cases and significantly worsens survival outcomes. Researchers analysed 4,391 melanoma cases from 2014 to 2018 using data from a statewide cancer registry affiliated with Surveillance Endpoints and End Results.
Key risk factors for upstaging included older age, male sex, non-White race, head or neck tumour location, larger tumour size, biopsy method, and delays between biopsy and surgical excision. In multivariable analysis, tumours on the head or neck and higher pathologic T stages were independently associated with upstaging.
Tumour upstaging led to changes in clinical management in over half of cases, yet only 37.4% of patients received recommended additional treatments. Upstaged melanomas showed significantly higher overall mortality (36.0% vs. 19.5%) and melanoma-specific mortality (9.0% vs. 2.9%) compared to non-upstaged tumours.
The findings underscore gaps in treatment adherence and the need for timely, targeted interventions to address upstaging risks. Despite its limitations as a single-centre retrospective study, the research highlights the urgency of improving melanoma care protocols to enhance survival outcomes.
These findings highlight critical gaps in treatment adherence and the importance of addressing factors that contribute to upstaging. Enhancing timely and targeted care protocols is essential to improving survival outcomes for patients with invasive melanoma.
Helena Bradbury, EMJ
Reference
Rosenthal A et al. Tumor upstaging in invasive melanoma is associated with changes in clinical management and worse prognosis. J Am Acad Dermatol. 2024;S0190-9622(24):03233-X.
