Rosenthal Amanda, Kim Joyce Y, Juhasz Margit L W, Conde Geena, Chen Clare, Eng Sarah, Carrasco Mendoza Cristo A, Chang Crystal T, Ticknor Iesha, Doan Leandra, Schwarzmann Kathyrn B, Garzione Sarah, Li Yunjie, Islas Zeuz A, Gharavi Nima M, Man Jeremy R
Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; Department of Dermatology, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
J Am Acad Dermatol. 2025 Mar;92(3):528-537. doi: 10.1016/j.jaad.2024.11.028. Epub 2024 Nov 22.
The clinical implications and prognostic outcomes associated with tumor upstaging in invasive melanoma have not been well established.
To determine the frequency of tumor upstaging in invasive melanoma, identify risk factors, and assess its impact on clinical management and outcomes.
A retrospective study using data from a statewide Surveillance Endpoints and End Results-affiliated cancer registry between 2014 and 2018 was performed. Multivariable hazard models were used to determine factors associated with upstaging and overall/melanoma-specific mortality.
Of 4391 cases of invasive melanoma, 9.4% were upstaged. Significant risk factors on univariate analysis 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. Significant risk factors on multivariable analysis included head/neck location and higher pathologic T stage. Tumor upstaging dictated a change in clinical management in over half of cases; however, only 37.4% fulfilled the recommendation for additional treatment. Upstaged melanomas experienced higher overall (36.0% versus 19.5%; P < .001) and melanoma-specific (9.0% versus 2.9%; P < .001) mortality compared to non-upstaged tumors.
Single-center retrospective study.
Tumor upstaging in invasive melanoma is associated with worse survival outcomes, possibly due to shortfalls in clinical management.
