Does Delay to Operation Impact Sentinel Lymph Node Status among Patients with Melanoma

Introduction: After melanoma diagnosis, various factors can delay therapy, including the COVID-19 pandemic. In this study, we examine the significance of surgical delay on sentinel lymph node (SLN) status in melanoma patients. Methods: Using the National Cancer Database, we examined surgical delay, defined as time from biopsy to surgical excision, for patients diagnosed with cutaneous melanoma who underwent tumor resection and SLN biopsy. Patients with clinically positive nodes were excluded. Logistic regression models were constructed to adjust for pertinent clinical factors. Results: From 2012-2017, 21,153 patients were included and 21.2% (n = 4,486) experienced a surgical delay of more than 45 days. Patients experiencing prolonged surgical delay were older (older than 75 years), lived farther from their reporting hospital, had Medicaid or were uninsured, or had multiple comorbidities (all, p 0.001). In adjusted analyses, the odds of SLN metastasis increased by 1% per day of surgical delay (odds ratio [OR] 1.01;95% CI, 1.00 to 1.01;p = 0.003) and by 19% for surgical delay more than 45 days (OR 1.19;95% CI, 1.02 to 1.39;p = 0.026). Surgical delay more than 45 days was associated with increased risk of SLN metastasis in the following scenarios: nonulcerated tumors (OR 1.23;95% CI, 1.04 to 1.46;p = 0.017), age 65 through 74 years (OR 1.46;95% CI, 1.06 to 2.02;p = 0.019), or thickness 1.00 to 1.99 mm (OR 1.27;95% CI, 1.00 to 1.60;p = 0.048). Conclusions: Tumor ulceration, thickness, and patient age confer increased risk of SLN metastasis when surgical delay occurs. In light of COVID-19-related delays in diagnosis and treatment, particular patients appear to benefit from timely SLN biopsy.