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One in five Medicare beneficiaries could experience delay in surgery for melanoma

More than 20% of Medicare beneficiaries experienced a delay of longer than 1.5 months for surgical treatment of melanoma, according to results of a recently published population-based study.

Researchers used the Surveillance, Epidemiology and End Results-Medicare database to conduct a retrospective study of 32,501 Medicare beneficiaries who were diagnosed with melanoma between Jan. 1, 2000, and Dec. 31, 2009. The patients had undergone surgical excisions after having their melanoma diagnosed by skin biopsy. The time from biopsy to surgical excision was used as the study’s main outcome.

The majority of patients were white (95.4%), male (63.1%), 75 years or older (60.8%) and had not been diagnosed with a prior melanoma (93.7%). Head and neck were the most frequent locations of the melanomas (40.5%), and 15,665 of the cases (48.2%) were in situ.

There were 25,269 of the cases (77.7%) that had excision performed within 1.5 months of biopsy. Another 7,232 cases (22.3%) were treated after 1.5 months, and 2,620 patients (8.1% of all patients) waited more than 3 months until excision.

Patients 85 years of age or older had a significantly increased risk-adjusted surgical delay when compared with patients younger than 65 years of age (OR=1.28; 95% CI, 1.04-1.55), patients with a prior melanoma (OR=1.20; 95% CI, 1.08-1.34) and patients with increased comorbidity burden (OR=1.18; 95% CI, 1.09-1.27).

There was an association of risk of surgical delay of more than 1.5 months based on physician specialty, with the lowest likelihood of delay in melanomas that were biopsied and excised by a dermatologist (probability, 16%), whereas the highest likelihood of delay was associated with biopsy performed by a nondermatologist and excision by a primary care physicians (probability, 31%), according to the researchers. – by Bruce Thiel

Disclosures: Lott reports no relevant financial disclosures.  Please see the full study for a list of all other authors’ relevant financial disclosures.