Surgery as a single or combination treatment in skin cancer

The authors aimed to determine the differences between surgery alone or in combination with biopsy in treating skin cancer. 

Sentinel-node biopsy (removes tissue from the lymph node (site that holds immune cells) to determine cancer progression) is the standard-of-care in skin cancer. Wide local excision is a common form of treatment in patients with skin cancer sores. It involves surgically removing the cancerous tissue and a layer of healthy tissue surrounding the cancer. Margins are used to determine how much healthy tissue should be removed and depends on the tumor size and thickness.  

The aim of this study was to determine the benefits or surgery alone or in combination with biopsy in treating skin cancer.

5,840 patients were used in this study with an average follow-up time of 40-54 months. Patients were split into two groups – 2,931 patients who received biopsy and surgery and 2,909 patients who received surgery alone.

Patients treated with biopsy and surgery most commonly experienced metastatic recurrence (cancer spreads from the site of the first tumor) (42.1%) after 38 months and patients treated with surgery most commonly experienced local recurrence (recurrence at the original tumor site) (54.3%) after 31 months. 40.3% of patients with tumors more than 1mm thick who underwent biopsy and surgery experienced cancer recurrence of any type (local or spread to other parts) compared to 52.8% of patients who underwent surgery alone.

Patients who underwent biopsy and surgery had an improved disease-free survival (patients did not experience any signs or symptoms of cancer after treatment) compared to patients who underwent surgery, who had an increased risk of 40% of experiencing cancer growth. Patients who underwent biopsy and surgery who had cancer cells in their lymph nodes were 3 times more at risk of experiencing cancer progression and were 3 times more at risk of experiencing shorter melanoma-specific survival (patients who did not die from skin cancer) compared to patients who did not have cancer in their lymph nodes.

5-year disease-free survival rates were 51.2% in patients with positive lymph nodes compared to 81.4% in patients with negative lymph nodes. 5-year melanoma-specific survival rates were 63.8% in patients with positive lymph nodes compared to 88.9% in patients with negative lymph nodes. 

The authors conclude that there was not a significant difference in outcome in patients who received biopsy and surgery compared to surgery alone. 

Prospective studies are required to allow the results presented to be widely applied. 

If you are considering surgery as treatment for skin cancer please consult your doctor for potential risks and benefits.