Does the interval between melanoma diagnosis and surgery have an impact on outcomes? A systematic review and meta-analysis

Abstract

Studies report conflicting effects of the time interval between cutaneous melanoma excision and subsequent sentinel lymph node biopsy (SLNB). We conducted a meta-analysis to investigate the effects of time interval from diagnosis to SLNB on overall survival (OS), melanoma-specific survival (MSS) and recurrence-free survival (RFS). MethodsWe screened public databases for relevant studies published from January 1997 to April 2024. The study followed PRISMA guidelines (PROSPERO CRD42021240045). Risk of Bias for individual studies (Cochrane Collaboration ROBINS-E), and heterogeneity between studies (RevMan Web v7.4.0) were assessed. Pooled relative hazard ratios (HR) were calculated, and summaries of evidence were presented with GRADE. Results19,741 articles were identified. 13 studies had data for quantitative analysis including 66,283 patients. The cutoff for “early” SLNB was ≤43 days.MSS and RFS was worse in patients who underwent early SLNB with HR 0.75 (95 %CI 0.62–0.92) and 0.87 (95 %CI 0.77–0.98) respectively, but with significant cohort biases. The early and late groups had similar OS (HR 0.88 (95 %CI 0.76–1.02)). Where SLN positive patients were reported, there was no difference in MSS (HR 1.11 (95 %CI 0.75–1.66)) and RFS (HR 0.99 (95 %CI 0.88–1.11)). Some studies had significant confounding biases, with high-risk melanomas being over-represented in early SLNB cohorts. ConclusionsPatients undergoing SLNB for melanoma do not have demonstrable long-term advantages when performed <6 weeks compared to those between 6 and 12 weeks after primary excision biopsy. Clinicians and patients should gain confidence that SLNB performed up to 12 weeks does not negatively influence their long-term outcomes.