About 22% of Medicare beneficiaries experience a delay of longer than 1.5 months between melanoma diagnosis and surgery, according to findings from a retrospective cohort study.
Of 32,501 melanoma cases from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, about 77.7% underwent excision within 1.5 months of biopsy, and of those who underwent excision after 1.5 months, 8.1% experienced a delay of more than 3 months. The risk-adjusted incidence of surgical delay longer than 1.5 months was significantly increased for those aged 85 years and older, compared with those aged 65 years and younger (odds ratio, 1.28), for those with a prior melanoma (OR, 1.20), and for those with three or more Elixhauser comorbidities (OR, 1.18), Dr. Jason P. Lott of Yale University, New Haven, Conn. and his colleagues reported online April 8 in JAMA Dermatology.
The lowest risk of delay was among those who underwent biopsy and excision by dermatologists (probability, 16.5%), and the highest was among those with a biopsy performed by a nondermatologist and excised by a primary care physician (probability, 30.7%), the investigators said (JAMA Dermatol. 2015 April 8 [doi:10.1001/jamadermatol.2015.119]).
Dr. Jason P. Lott
The study, which provides the first population-based estimates of melanoma surgery delay among Medicare beneficiaries, and which shows that delays are relatively common, 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 investigators concluded.
This study was supported by the Robert Wood Johnson Foundation and the P30 Cancer Center Support Grant at the Yale Comprehensive Cancer Center.
Dr. Lott reported having no disclosures. Coauthor Dr. Cary P. Gross received research grant support from Johnson & Johnson, Merck, and 21st Century Oncology.