WEDNESDAY, Dec. 4, 2024 -- Tumor upstaging occurs in 9.4 percent of cases of invasive melanoma and is associated with higher overall and melanoma-specific mortality, according to a study published online Nov. 21 in the Journal of the American Academy of Dermatology.

Amanda Rosenthal, M.D., from the Kaiser Permanente Los Angeles Medical Center, and colleagues examined the frequency of tumor upstaging in invasive melanoma in a retrospective study using data from a statewide Surveillance Endpoints and End Results-affiliated cancer registry between 2014 and 2018. Factors associated with upstaging and overall/melanoma-specific mortality were assessed.

The researchers found that 9.4 percent of 4,391 cases of invasive melanoma were upstaged. In a univariate analysis, significant risk factors 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. In a multivariable analysis, significant risk factors included head/neck location and higher pathologic T stage. In more than half of cases, tumor upstaging dictated a change in clinical management; only 37.4 percent fulfilled the recommendation for additional treatment. Higher overall (36.0 versus 19.5 percent) and melanoma-specific (9.0 versus 2.9 percent) mortality were seen for upstaged melanomas compared with nonupstaged tumors.

"Our study highlights the significant clinical and prognostic implications of melanoma upstaging, particularly as it relates to surgical management, postoperative care, and patient outcomes," the authors write. "The 9.4 percent upstaging rate observed in our cohort underscores the importance of obtaining an adequate initial biopsy when sampling lesions suspicious for melanoma."