TOPLINE: 

In a cohort study, a delay in surgical treatment of 91 days or longer after diagnostic biopsy was associated with higher odds of positive surgical margins and worse long-term overall survival (OS) in patients with early-stage vulvar melanoma.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the National Cancer Database and identified 1857 patients (94% White) with stage I-II vulvar melanoma between 2004 and 2022 who were stratified by time to treatment initiation (TTI).
• TTI was categorized as 30 days or less, 31 to 59 days, 60 to 90 days, and 91 days or longer duration from diagnostic biopsy to definitive surgery.
• Researchers assessed positive margins, defined as microscopic or macroscopic residual tumor at the final surgical margin, and OS.

TAKEAWAY:

• Overall, 15.9% of the patients had positive surgical margins; patients with TTI of at least 91 days had higher odds of positive surgical margins than those treated within 30 days (adjusted odds ratio [aOR], 1.725; P = .015), while delays shorter than 91 days were not significantly associated with margin positivity.
• TTI was not associated with OS during the first 36 months of follow-up (adjusted hazard ratio [aHR], 1.033; P = .866).
• Beyond 36 months, TTI of 91 days or longer was associated with higher mortality than TTI of 30 days or less (aHR, 1.583; P = .011).
• Longer treatment delays were more common in more recent years and among non-White patients and were associated with a greater comorbidity burden.

IN PRACTICE:

"Our results suggest that prolonged surgical delays (≥ 91 days) are associated with higher odds of positive margins and worse long-term OS in early-stage vulvar melanoma," the authors wrote, adding that the increase in treatment delays in the more recent years indicates a “temporal trend" that warrants further attention. "Taken together, these observations highlight the potential clinical importance of timely definitive surgical treatment in early-stage vulvar melanoma."

SOURCE:

The study was led by Hue T.T. Tran, MD, department of dermatology, Mayo Clinic, Rochester, Minnesota, and was published online as a brief report on June 10 in the Journal of the American Academy of Dermatology.

LIMITATIONS: 

The study was limited by its retrospective design. Additionally, lack of melanoma-specific survival and recurrence data, biopsy details, surgical technique, surgeon experience, and reasons for treatment delay were not available in the database. 

DISCLOSURES:

The study did not receive any specific funding. The authors did not declare any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.