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One in Five Medicare Patients With Melanoma Experience Surgical Delays

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Key Points

  • One in five Medicare beneficiaries diagnosed with melanoma experience a delay of surgery that is longer than 1.5 months.
  • The highest likelihood of surgical delay occurred when the biopsy was performed by a nondermatologist and excised by a primary care physician. Similar findings were observed for a delay longer than 3 months.
  • Those melanoma patients undergoing biopsy and surgery by dermatologists had the lowest risk for surgical delay, presenting potential opportunities for improved access to and coordination of dermatologic care.

A large retrospective cohort study of more than 32,000 Medicare beneficiaries diagnosed with melanoma has found that one in five patients experience a delay of surgery that is longer than 1.5 months. Those patients undergoing biopsy and surgery by dermatologists had the lowest risk for delay, which may provide opportunities to increase coordination of care between providers who diagnose and treat patients with melanoma. The study by Lott et al is published in JAMA Dermatology.

Study Methodology

The study researchers performed a retrospective cohort study of 32,501 Medicare beneficiaries diagnosed with melanoma from January 1, 2000, through December 31, 2099, using information from the Surveillance, Epidemiology, and End Results-Medicare linked database. The researchers included all patients undergoing surgical excision of melanoma diagnosed by means of skin biopsy.

Surgical delay was measured as the time from the biopsy to surgical excision. The researchers estimated risk-adjusted odds ratios (ORs) and marginal probabilities of delay with 95% confidence intervals (CIs) for each covariate using mixed-effects logistic regression.

Study Findings

The investigators found that melanomas were most frequently located on the head and neck (40.5%) and staged as in situ disease (48.2%). More than three-quarters of cases (25,269 [77.7%]) underwent excision within 1.5 months of biopsy. Among those treated after 1.5 months (7,232 [22.3%]), 2,620 (8.1% of all cases) experienced a delay of longer than 3 months. The incidence of a risk-adjusted surgical delay longer than 1.5 months was significantly increased among patients 85 years or older compared with those younger than 65 years (OR = 1.28, 95% CI = 1.05–1.55; P = .02), those with a prior melanoma (OR = 1.20, 95% CI = 1.08–1.34; P = .001), and those with an increased comorbidity burden (OR = 1.18, 95% CI = 1.09–1.27; P < .001).

Melanomas that underwent biopsy and excision by dermatologists had the lowest likelihood of delay (probability = 16%, 95% CI = 14%–18%). The highest likelihood of delay (probability = 31%, 95% CI = 24%–37%) occurred when the biopsy was performed by a nondermatologist and excised by a primary care physician. Similar findings were observed for a delay longer than 3 months.

“Those patients undergoing biopsy and surgery by dermatologists have the lowest risk for delay, highlighting potential opportunities for improved access to and coordination of dermatologic care,” concluded the study authors.

Jason P. Lott, MD, MHS, MSHP, of Yale University School of Medicine, is the corresponding author for the JAMA Dermatology article.

The study was funded by the Robert Wood Johnson Foundation and the P30 Cancer Center Support Grant at Yale Cancer Center. Cary P. Gross, MD, MPH, has received research grant support from Johnson & Johnson, Merck, and 21st Century Oncology.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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