. Author manuscript; available in PMC: 2012 Oct 1.

Published in final edited form as: Ann Surg Oncol. 2011 Apr 9;18(10):2925–2936. doi: 10.1245/s10434-011-1706-3

Table 5.

Multivariable Cox Proportional Hazard Models Showing Risk of Overall and Melanoma-specific Mortality, by Surgery Type

Overall
	Biopsy	Wide excision	Amputation	Surgery NOS
	HR (95% CI)	HR (95% CI)	HR (95% CI)	HR (95% CI)
Age	1.004 (1.004–1.005)^a	1.005 (1.005–1.005)^a	1.02 (1.01–1.04)^a	1.004 (1.004–1.004)^a
Sex
Male	1.00	1.00	1.00	1.00
Female	0.72 (0.69–0.76)^a	0.69 (0.66–0.72)^a	0.86 (0.62–1.20)	0.72 (0.68–0.75)^a
Race
White	1.00	1.00	1.00	1.00
Black	1.36 (1.01–1.83)^b	1.58 (1.27–1.95)^a	1.40 (0.81–2.43)	1.76 (1.42–2.17)^a
Other	1.15 (.91–1.46)	0.92 (0.75–1.13)	1.28 (0.73–2.24)	1.01 (.82–1.25)
Stage
In situ	1.00	1.00	1.00	1.00
Local	1.31 (1.18–1.47)^a	1.47 (1.32–1.64)^a	2.91 (0.13–67.96)	1.22 (1.06–1.42)^c
Regional	4.69 (3.99–5.51)^a	5.01 (4.41–5.69)^a	7.10 (0.30–166.53)	2.74 (2.34–3.20)^a
Distant	17.52 (14.35–21.39)^a	9.97 (8.23–12.07)^a	9.91 (0.39–247.72)	6.81 (5.73–8.09)^a
Unstaged	1.84 (1.52–2.25)^a	1.47 (1.21–1.78)^a	4.12 (0.17–101.29)	2.20 (1.88–2.58)^a
Anatomic site
Trunk	1.00	0.99 (0.94–1.04)	1.00	1.00
Upper extremity	1.04 (0.97–1.13)	1.00	0.61 (0.26–1.46)	0.90 (0.85–0.96)^c
Lower extremity	0.89 (0.81–0.97)^b	0.85 (0.79–0.90)^a	0.75 (0.31–1.79)	0.92 (0.86–0.98)^b
Overlap & NOS	0.93 (0.80–1.07)	1.07 (0.86–1.32)	0.76 (0.17–3.25)	1.20 (1.09–1.33)^c
Head and neck	1.66 (1.55–1.78)^a	1.55 (1.47–1.63)^a	1.26 (0.48–3.33)	1.31 (1.23–1.39)^a
Histologic subtype
In situ	1.00	1.00	1.00	1.00
MM	1.81 (1.58–2.08)^a	1.56 (1.36–1.78)^a	0.38 (.02–8.77)	1.91 (1.49–2.46)^a
NM	3.19 (2.74–3.73)^a	2.73 (2.37–3.14)^a	0.82 (.03–19.42)	2.48 (1.93–3.21)^a
LMM	2.07 (1.88–2.28)^a	1.87 (1.68–2.08)^a	0.70 (.03–16.21)	2.38 (1.89–3.00)^a
SSM	1.13 (0.98–1.30)	1.09 (0.96–1.25)	0.46 (0.02–11.09)	1.33 (1.04–1.72)^b
ALM	2.65 (1.85–3.81)^a	2.65 (2.17–3.24)^a	0.34 (0.01–7.94)	2.78 (1.82–4.25)^a
Satellite Nodules
No	1.00	1.00	1.00	1.00
Yes	1.01 (0.72–1.42)	1.34 (1.07–1.68)^b	0.83(0.34–2.04)	1.37 (1.17–1.59)^a
Unknown	0.67 (0.53–0.85)^c	0.71 (0.61–0.83)^a	0.69 (0.31–1.53)	0.91 (0.75–1.10)
LN Extension
No	1.00	1.00	1.00	1.00
Regional	1.21 (0.98–1.50)	1.35 (1.20–1.51)^a	1.41 (0.80–2.52)	1.24 (1.12–1.37)^a
Distant	1.59 (1.20–2.12)^c	1.39 (1.03–1.89)^b	1.65 (0.51–5.36)	0.97 (0.79–1.19)
Unknown	1.03 (0.96–1.11)	1.03 (0.99–1.08)	1.42 (0.97–2.10)	1.13 (1.06–1.22)^c
Tumor ulceration
No	1.00	1.00	1.00	1.00
Yes	1.10 (0.95–1.29)	1.05 (0.96–1.15)	1.46 (0.90–2.38)	1.08 (1.01–1.15)^b
Unknown	1.73 (1.49–2.01)^a	1.83 (1.61–2.09)^a	1.27 (0.65–2.50)	1.01 (0.94–1.08)
Years of diagnosis
1973–1977				0.67 (0.40–1.14)
1978–1982				0.59 (0.35–1.01)
1983–1987	0.92 (0.76–1.11)	0.93 (0.78–1.11)	1.70 (0.62–4.67)	0.65 (0.38–1.10)
1988–1992	1.49 (1.30–1.70)^a	1.43 (1.26–1.62)^a	1.93 (0.84–4.41)	0.64 (0.37–1.08)
1993–1997	1.30 (1.14–1.48)^c	1.32 (1.16–1.49)^a	2.66 (1.21–5.89)^b	0.62 (0.36–1.06)
1998–2002	1.14 (1.00–1.30)^b	1.08 (0.96–1.22)	2.09 (0.96–4.58)	0.59 (0.33–1.06)
2003–2004	1.00	1.00	1.00	1.00

Melanoma-specific
	Biopsy	Wide excision	Amputation	Surgery NOS
	HR (95% CI)	HR (95% CI)	HR (95% CI)	HR (95% CI)
Age	1.003 (1.002–1.004)^a	1.004 (1.004–1.005)^a	1.002 (0.99–1.02)	1.003 (1.003–1.004)^a
Sex
Male	1.00	1.00	1.00	1.00
Female	0.63 (0.57–0.70)^a	.64 (0.60–0.68)^a	0.69 (0.45–1.06)	0.67 (0.63–0.72)^a
Race
White	1.00	1.00	1.00	1.00
Black	1.09 (0.67–1.76)	1.28 (0.94–1.76)	1.16 (0.59–2.27)	1.70 (1.30–2.23)^c
Other	0.85 (0.52–1.37)	0.95 (0.71–1.27)	1.23 (0.60–2.52)	0.99 (0.76–1.32)
Stage
In situ	0.08 (0.04–0.18)^a	0.07 (0.04–0.14)^a	0.00 (0.00–0.00)	0.12 (0.06–0.23)^a
Local	1.00	1.00	1.00	1.00
Regional	7.11 (5.98–8.46)^a	4.95 (4.49–5.45)^a	2.96 (1.65–5.28)^c	2.91 (2.67–3.17)^a
Distant	30.43 (24.38–37.99)^a	10.86 (8.98–13.13)^a	4.85 (1.94–12.14)^c	7.78 (6.92–8.76)^a
Unstaged	2.74 (2.19–3.44)^a	1.11 (0.90–1.39)	1.75 (0.52–5.89)	2.48 (2.25–2.73)^a
Anatomic site
Trunk	1.00	1.00	1.00	1.00
Upper extremity	0.74 (0.64–0.85)^a	0.70 (0.65–0.77)^a	0.60 (0.21–1.73)	0.72 (0.66–0.78)^a
Lower extremity	0.85 (0.73 –0.99)^b	0.82 (0.76–0.90)^a	0.88 (0.31–2.52)	0.83 (0.76–0.90)^a
Overlap & NOS	0.67 (0.54–0.84)^c	0.74 (0.53–1.02)	0.69(0.10–4.51)	0.90 (0.80–1.01)
Head and neck	0.96 (0.84–1.09)	1.13 (1.04–1.22)^c	1.19 (0.36–3.93)	0.91 (0.84–.99)^b
Histologic subtype
In situ	0.42 (0.18–0.99)^b	0.51 (0.24–1.07)	0.00 (0.00–0.00)	.68 (0.29–1.59)
MM	1.00	1.00	1.00	1.00
NM	1.90 (1.67–2.17)^a	1.99 (1.85–2.16)^a	1.98 (1.10–3.55)^b	1.32 (1.21–1.43)^a
LMM	0.33 (0.24–0.45)^a	0.46 (0.38–0.56)^a	2.00 (0.37–10.91)	0.58 (0.47–0.72)^a
SSM	0.53 (0.46–0.61)^a	0.69 (0.64–0.75)^a	1.16 (0.50–2.69)	.63 (0.58–0.68)^a
ALM	1.35 (0.80–2.28)	1.63 (1.32–2.01)^a	0.96 (0.58–1.59)	1.45 (0.98–2.15)
Satellite Nodules
No	1.00	1.00	1.00	1.00
Yes	0.94 (0.65–1.37)	1.20 (0.94–1.54)	0.83 (0.28–2.41)	1.39 (1.18–1.65)^c
Unknown	0.81 (0.61–1.08)	0.72 (0.59–0.87)^c	0.61 (0.23–1.61)	0.76 (0.60–0.97)^b
LN Extension
No	1.00	1.00	1.00	1.00
Regional	1.51 (1.17–1.96)^c	1.69 (1.48–1.93)^a	1.54 (0.75–3.13)	1.30 (1.15–1.46)^a
Distant	1.85 (1.34–2.57)^c	1.56 (1.12–2.18)^c	1.10 (0.26–4.66)	0.95 (0.75–1.20)
Unknown	1.24 (1.09–1.41)^c	1.10 (1.02–1.17)^b	1.32 (0.79–2.19)	1.02 (0.93–1.12)
Tumor ulceration
No	1.00	1.00	1.00	1.00
Yes	1.05 (0.84–1.29)	1.06 (0.95–1.19)	1.44 (0.79–2.60)	1.02 (0.93–1.12)
Unknown	1.82 (1.49–2.23)^a	2.25 (1.92–2.65)^a	1.43 (0.64–3.19)	1.03 (0.94–1.14)
Years of diagnosis
1973–1977				1.01 (0.48–2.13)
1978–1982				0.85 (0.40–1.80)
1983–1987	1.23 (0.95–1.60)	1.08 (0.86–1.37)	1.39 (0.40–4.83)	0.97 (.046–2.06)
1988–1992	1.52 (1.21–1.91)^c	1.71 (1.41–2.06)^a	2.55 (0.92–7.03)	0.96 (0.45–2.03)
1993–1997	1.29 (1.04–1.61)^b	1.45 (1.21–1.75)^a	2.64 (0.98–7.15)	0.90 (0.42–1.89)
1998–2002	1.06 (0.86–1.32)	1.08 (0.91–1.29)	1.97 (0.74–5.27)	0.59 (0.26–1.35)
2003–2004	1.00	1.00	1.00	1.00

P < 0.0001.

P < 0.05.

P < 0.01.

Abbreviations: HR = Hazard Ratio, CI = confidence interval, MM = malignant melanoma, NM = nodular melanoma, LMM = lentigo maligna melanoma, SSM = superficial spreading melanoma, ALM = acral lentiginous melanoma, LN = Lymph Node.

Comparisons for each type of surgery were adjusted for all the variables shown in the table. Type of surgery was not coded in SEER prior to 1983; all surgeries were categorized as Surgery NOS for the 1973–1982 years of diagnosis.