It is not uncommon for Medicare patients with melanoma to experience considerable delays in surgery, despite the risks of putting off excision, according to new research published in JAMA Dermatology.
Melanoma is the leading cause of new cancer diagnoses in the country, as well as the leading cause of skin cancer-related deaths. Delaying surgical excision of melanoma may lead to increased illness and death from other malignant neoplasms, and significant anxiety and stress.
Researchers from the Yale University School of Medicine in New Haven, Conn., examined more than 32,000 cases of melanoma among Medicare patients between January 2000 and December 2009 using the Surveillance, Epidemiology, and End Results-Medicare database.
The results of their findings are highlighted below:
- Roughly 78 percent of melanoma cases underwent excision with 1.5 months.
- One in five patients (22.3) experienced a delay of surgery that was longer than 1.5 months.
- About 8 percent of patients waited longer than three months for surgery.
- Surgical delays longer than 1.5 months were significantly higher among people 85 years old or older compared with those younger than 65, 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.
"Although no gold standard exists to judge appropriate versus 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," wrote the study authors.