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Frequency of and risk factors for tumor upstaging after wide local excision of primary cutaneous melanoma. 2017

Jeremy R Etzkorn, and John M Sharkey, and John W Grunyk, and Thuzar M Shin, and Joseph F Sobanko, and Christopher J Miller
Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania. Electronic address: jeremy.etzkorn@uphs.upenn.edu.

BACKGROUND Detecting a more advanced stage of the primary melanoma after wide local excision and reconstruction can complicate patient counseling about prognosis, management of surgical margins, and indications for sentinel lymph node biopsy. OBJECTIVE To identify the frequency of and risk factors associated with upstaging after wide local excision of primary melanoma. METHODS Retrospective, single center, cross-sectional study of 1332 consecutive in situ to stage T4a melanomas treated with wide local excision. RESULTS The overall rate of upstaging of melanoma was 3.9% (52/1332). After multivariate analysis, the greatest risk factor for upstaging was anatomic location on the head, neck, hands, feet, genitals, or pretibial leg (odds ratio [OR] 7.06, P < .001) followed by extension of the melanoma to the base of the biopsy specimen (OR 3.42, P < .001); the need for multiple preoperative scouting biopsies (OR 1.89, P = .004); older age (OR 1.03 per year, P = .002); and nonlentigo maligna histologic subtype (OR 3.6, P = .002). CONCLUSIONS This was a single-site, retrospective observational study. CONCLUSIONS Clinicopathologic characteristics, particularly anatomic location on the head, neck, hands, feet, genitals, or pretibial leg and subtotal diagnostic biopsies, identify melanomas with an increased risk for upstaging.

UI MeSH Term Description Entries
D007866 Leg The inferior part of the lower extremity between the KNEE and the ANKLE. Legs
D008297 Male Males
D008545 Melanoma A malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites. It occurs mostly in adults and may originate de novo or from a pigmented nevus or malignant lentigo. Melanomas frequently metastasize widely, and the regional lymph nodes, liver, lungs, and brain are likely to be involved. The incidence of malignant skin melanomas is rising rapidly in all parts of the world. (Stedman, 25th ed; from Rook et al., Textbook of Dermatology, 4th ed, p2445) Malignant Melanoma,Malignant Melanomas,Melanoma, Malignant,Melanomas,Melanomas, Malignant
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009367 Neoplasm Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Cancer Staging,Staging, Neoplasm,Tumor Staging,TNM Classification,TNM Staging,TNM Staging System,Classification, TNM,Classifications, TNM,Staging System, TNM,Staging Systems, TNM,Staging, Cancer,Staging, TNM,Staging, Tumor,System, TNM Staging,Systems, TNM Staging,TNM Classifications,TNM Staging Systems
D003430 Cross-Sectional Studies Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time. Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D005260 Female Females
D005528 Foot The distal extremity of the leg in vertebrates, consisting of the tarsus (ANKLE); METATARSUS; phalanges; and the soft tissues surrounding these bones. Feet
D005835 Genitalia The external and internal organs involved in the functions of REPRODUCTION. Accessory Sex Organs,Genital Organs,Sex Organs, Accessory,Genital System,Genitals,Reproductive Organs,Reproductive System,Accessory Sex Organ,Genital,Genital Organ,Genital Systems,Organ, Accessory Sex,Organ, Genital,Organ, Reproductive,Organs, Accessory Sex,Organs, Genital,Organs, Reproductive,Reproductive Organ,Reproductive Systems,Sex Organ, Accessory,System, Genital,System, Reproductive,Systems, Genital,Systems, Reproductive
D006225 Hand The distal part of the arm beyond the wrist in humans and primates, that includes the palm, fingers, and thumb. Hands

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