title: Factors influencing time between biopsy and definitive surgery for malignant melanoma: do they impact clinical outcome?
abstract: BACKGROUND
  Whether time between biopsy and surgery for malignant melanoma affects clinical outcomes is sparsely defined. This study evaluated factors influencing surgical interval and surgical interval effect on outcomes.
  
  
  METHODS
  We performed a review of a prospective 10-year, single-institution database.
  
  
  RESULTS
  There were 473 patients treated for 478 malignant melanomas. The mean surgical interval was 30.5 days. The mean thickness was 2.1 mm; 46% of patients had a surgical interval of more than 28 days whereas 8% had a surgical interval of more than 56 days. Residual melanoma was found at excision in 170 (36%) patients. Age, sex, and referral source significantly affected surgical interval, however, lesion thickness, sentinel lymph node status, ulceration, and residual melanoma at excision did not. In univariate Cox models, neither a surgical interval of 28 or less nor less than 56 days showed better overall survival (OS) or disease-free survival (DFS). In multivariate Cox models of OS and DFS including lesion thickness, sentinel lymph node status, ulceration, and residual melanoma at excision, neither a surgical interval of 28 days or fewer nor a surgical interval of 56 days or fewer significantly affected outcomes.
  
  
  CONCLUSIONS
  Age, sex, referral source, and lesion thickness were associated with surgical interval. Immediate surgery for malignant melanoma does not significantly impact OS or DFS.
authors.affiliation: Department of General Surgery, Mayo Clinic Scottsdale, Phoenix, AZ, USA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Carpenter
authors.forename: Barbara
authors.initials: B
authors.lastname: Pockaj
authors.forename: Amylou
authors.initials: A
authors.lastname: Dueck
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.forename: David
authors.initials: D
authors.lastname: Kurtz
authors.forename: Aleksander
authors.initials: A
authors.lastname: Sekulic
authors.forename: William
authors.initials: W
authors.lastname: Casey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods*; D013997:Time Factors; D055815:Young Adult