Medicare beneficiaries have a lower rate of delayed melanoma surgeries

1. The vast majority (>75%) of Medicare beneficiaries studied underwent excision of their melanoma within 1.5 months of their biopsy.

2. Surgical delay of melanoma resection, as measured by time between biopsy and surgical excision, was least likely in patients being managed by dermatologists.

Evidence Rating Level: 2 (Good)           

Study Rundown: Melanoma is a potentially deadly form of skin cancer that is an important cause of new cancer diagnoses in the United States. The primary modality for melanoma treatment is surgical excision, and while no studies have proven that delay in surgery affects mortality, there have also been no studies quantifying the extent of surgical delay in those affected by the disease. The authors of this study aimed to document surgical delay among Medicare beneficiaries with melanoma. About 1 in 5 patients in the study experienced a delay greater than 1.5 months between biopsy and excision for melanoma. Furthermore, patients ≥85 and with increased co-morbidity burden were most likely to experience delay. The large cohort size strengthened the study; however, the results were limited to those enrolled in the traditional Medicare fee-for service plan, which may have limited generalizability.

Click to read the study in JAMA Dermatology

Relevant Reading: Timely surgical follow-up for melanoma among Medicare beneficiaries

In-Depth [retrospective cohort]: The cohort consisted of 32,501 cases of melanoma. The cohort was primarily composed of white males ≥75 years old that had melanomas staged as in situ disease. Both the initial biopsy and excision were most commonly performed by dermatologists (88.4% and 41.9%, respectively) with the remaining excisions performed by general/plastic surgeons (30.5%), Mohs surgeons (9.1%) or primary care physicians (1.2%). Seventy eight percent of patients underwent excisional surgery within 1.5 months of biopsy. Of those who had surgery after 1.5 months, 8.1% of cases experienced a delay longer than 3 months. As compared to those younger than 65 years old, patients ≥85 had significantly increased risk-adjusted surgical delay longer than 1.5 months (odds ratio [OR], 1.28 [95% CI, 1.05-1.55]; P = .02), as did those with a prior melanoma (OR, 1.20 [95% CI, 1.08-1.34]; P = .001) and those with increased comorbidity burden (OR, 1.18 [95% CI, 1.09-1.27]; P < .001). The lowest likelihood of delay was seen in melanomas biopsied and excised by a dermatologist (16% probability, 95% CI, 14%-18%). In contrast, the highest likelihood of delay was seen when biopsy was performed by a non-dermatologist and then excised by a primary care physician (31% probability, 95% CI 24%-37%).

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