Time to Treatment: Outcomes after SNB for melanoma
Research type
Research Study
Full title
Correlating Clinical Outcomes with Time-to-Treatment Parameters for Primary Cutaneous Melanoma Patients in a Large UK Tertiary Referral Cancer Centre - Implications for Setting National Guidelines
IRAS ID
332188
Contact name
Marc Moncrieff
Contact email
Sponsor organisation
Norfolk & Norwich University Hospital Foundation NHS Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Melanoma is the fifth most common cancer in the UK, where a 32% increase was noted over the last decade. Melanoma is particularly important because it usually affects younger patients, with nearly half diagnosed before 65 years. After diagnosis, a wide local excision is required at the primary site of melanoma to prevent relapse; plus, a sentinel node biopsy (SNB) to accurately stage the patient and determine whether onward referral for adjuvant immunotherapy is appropriate to prevent further relapse. In the UK, approximately 30% of patients diagnosed with melanoma require the procedure (about 175 per annum in Norwich). If a metastasis is detected, the distant relapse risk is determined by the sentinel lymph node deposit size. A small deposit (<0.5mm in diameter) marks a low likelihood of metastasis and immunotherapy is not indicated; whereas a larger deposit (>1mm) indicates an increased risk of metastasis immunotherapy is indicated.
Since the covid-19 pandemic, the time interval between diagnosis and referral for definitive surgery has dramatically increased for melanoma patients across the UK, including Norwich, the regional skin cancer service for the eastern half of the East of England. Surgery is now being routinely performed beyond 90 days. These delays may be producing an upstaging of a significant proportion of melanoma patients, by impacting on metastatic deposit size at SNB, metastasis and immunotherapy use, affecting overall melanoma survival. There is no evidence to support this hypothesis because the historic data discusses the delays from 30-90 days rather than beyond 90 days.
This is a retrospective cohort study, assessing the relationship between the diagnosis and subsequent surgery (particularly SNB) time interval (90 days or less, or greater than 90 days) and prognostic biomarkers, such as sentinel node deposit size, in melanoma patients who underwent treatment at the Norfolk and Norwich University Hospital between 2010-2023.
REC name
East of England - Essex Research Ethics Committee
REC reference
23/EE/0283
Date of REC Opinion
3 Jan 2024
REC opinion
Favourable Opinion