Melanoma is the leading cause of skin cancer¬related deaths and surgical excision is the primary therapy for melanoma. It is recommended that melanomas should be excised within 4 to 6 weeks of the diagnostic biopsy because surgical delay may result in the potential for increased illness and death from other malignant neoplasms, along with anxiety and stress. 

In a study that included more than 32,000 cases of melanoma among Medicare patients, approximately 20 percent experienced a delay of surgery that was longer than 1.5 months, and about 8 percent of patients waited longer than 3 months for surgery.

Jason P. Lott, M.D., M.H.S., M.S.H.P., of the Yale University School of Medicine, New Haven, Conn., and colleagues examined surgical delay among Medicare beneficiaries diagnosed as having melanoma between January 2000 and December 2009, using the Surveillance, Epidemiology, and End Results-Medicare database. The researchers included all patients undergoing surgical excision of melanoma diagnosed by means of results of skin biopsy.

The study included 32,501 cases of melanoma; patients were more likely to be 75 years or older (61 percent) and to have no prior melanoma (94 percent). Of the total study population, 78 percent of melanoma cases underwent excision within 1.5 months, 22.3 percent underwent excision after 1.5 months, and 8.1 percent underwent excision after 3 months. Surgical delay longer than 1.5 months was significantly increased among patients 85 years or older compared with those younger than 65 years, those with a prior melanoma, and those with more co-existing medical conditions.

Melanomas that underwent biopsy and excision by dermatologists had the lowest likelihood of delay; the highest likelihood of delay occurred when the biopsy was performed by a nondermatologist and excised by a primary care physician.

"Our results show that a delay of surgery for melanoma may be relatively common among Medicare beneficiaries. Although no gold standard exists to judge appropriate vs inappropriate surgical delay, minimization of delay is an important patient¬centered objective of high-quality dermatologic care, especially given the potential harms of psychological stress associated with untreated malignant neoplasms. Our study highlights opportunities for quality improvement in dermatologic care and suggests that efforts to minimize the delay of surgery for melanoma might focus on increased access to dermatologic expertise and enhanced coordination of care among different specialists," the authors write.

Citation: JAMA Dermatology. April 8, 2015. doi:10.1001/jamadermatol.2015.119