Frequency of and risk factors for tumor upstaging after wide local excision of primary cutaneous melanoma

Background Detecting a more advanced stage of the primary melanoma after wide local excision and reconstruction can complicate patient counseling about prognosis, management of surgical margins, and indications for sentinel lymph node biopsy. Objective To identify the frequency of and risk factors a...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2017-08, Vol.77 (2), p.341-348
Main Authors: Etzkorn, Jeremy R., MD, Sharkey, John M., BA, Grunyk, John W., BA, Shin, Thuzar M., MD, PhD, Sobanko, Joseph F., MD, Miller, Christopher J., MD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Biopsy
conventional excision
Cross-Sectional Studies
Dermatology
Female
Foot
Genitalia
guidelines
Hand
Head and Neck Neoplasms - pathology
Head and Neck Neoplasms - surgery
Humans
Leg
Male
Margins of Excision
melanoma
Melanoma - pathology
Melanoma - surgery
Middle Aged
Mohs surgery
Neoplasm Staging
Neoplasm, Residual
prognosis
reconstruction
Retrospective Studies
Risk Factors
sentinel lymph node biopsy
Skin - pathology
Skin Neoplasms - pathology
Skin Neoplasms - surgery
upstaging
wide local excision
Young Adult
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Summary:Background Detecting a more advanced stage of the primary melanoma after wide local excision and reconstruction can complicate patient counseling about prognosis, management of surgical margins, and indications for sentinel lymph node biopsy. Objective To identify the frequency of and risk factors associated with upstaging after wide local excision of primary melanoma. Methods Retrospective, single center, cross-sectional study of 1332 consecutive in situ to stage T4a melanomas treated with wide local excision. Results The overall rate of upstaging of melanoma was 3.9% (52/1332). After multivariate analysis, the greatest risk factor for upstaging was anatomic location on the head, neck, hands, feet, genitals, or pretibial leg (odds ratio [OR] 7.06, P  
ISSN:0190-9622
1097-6787
DOI:10.1016/j.jaad.2017.03.018