Effect of Ulceration on the Therapeutic Benefit of Surgery in Patients with Stage IV Melanoma: A Surveillance, Epidemiology, and End Results Analysis from 2004–2015

Abstract

Background: The effects of various surgical options and ulcerations on the survival of patients with stage IV skin malignant melanoma are unknown. Therefore, we evaluated the potential of these factors as prognostic markers in patients with stage IV malignant melanoma. Methods: We included 5760 patients from 2004–2015 who are screened from the SEER datasets in the study. The patients were divided into four groups: the R 0 group, the primary tumor resection group, the metastasectomy group, and the no-resection group. The median follow-up survival time and overall survival were compared between the four groups as primary outcomes. Result: The R0 , primary tumor resection, metastasectomy, and no-resection groups had median survival times of 11, 13, 20, and 4 months, respectively ( p <0.001). Cox (proportional hazards) regression models estimated that patients in the R 0 , primary tumor resection, and metastasectomy groups had longer survival benefits, with hazard ratios of 0.396 (95% confidence interval [CI], 0.347–0.453), 0.509 (95% CI, 0.465–0.556), and 0.481 (95% CI, 0.447–0.519), respectively. Conclusion: We highlight the importance of surgery in metastatic melanoma; each surgical group in this study is independently correlated with increased survival. In addition, the patient’s ulceration status is able to predict surgical treatment; however, in the ulcerated melanoma cases, caution should be exercised when considering a metastasectomy.