Impact of Surgical Refusal on Overall Survival in Patients With Melanoma: A Comprehensive Analysis

Background/Aim: Surgery is the primary treatment for melanoma, but some patients refuse it, potentially affecting survival. This study examines demographic and clinical factors associated with surgery refusal to inform targeted interventions. Patients and Methods: We conducted a retrospective cohort study using the National Cancer Database (NCDB) to analyze factors linked to surgery refusal in melanoma patients. Demographic, clinical, and treatment characteristics were compared using Pearson Chi-square and Wilcoxon Rank Sum tests. Results: Among 1,048,575 melanoma patients considered for surgery, 605 (0.1%) refused. Those who refused were older (mean age 75.8 years), had more comorbidities, and were more likely to be racial minorities or socioeconomically disadvantaged (p<0.001). Survival analysis showed a lower overall survival rate in the refusal group, with 66.0% alive at follow-up compared to 78.3% in the non-refusal group. Conclusion: Surgery refusal in melanoma patients is associated with advanced age, frailty, and socioeconomic disadvantages, including racial minority status and lower income. Addressing these barriers may improve treatment acceptance and survival outcomes.