1 in 5 Medicare Patients Faces Delay in Melanoma Surgery: Study

Long waits can be anxiety-provoking

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HealthDay Reporter

WEDNESDAY, April 8, 2015 (HealthDay News) -- More than 20 percent of Medicare patients with melanoma, the deadliest form of skin cancer, face delays in getting surgical treatment, a new study reveals.

Researchers evaluated more than 32,000 melanoma patients covered by Medicare, the publicly funded insurance program for the elderly in the United States.

"We found around one in five Medicare patients experience a delay greater than 1.5 months and that 8 percent had surgery after three months," said study researcher Dr. Jason Lott, who conducted the research while a postdoctoral fellow in dermatology at the Yale School of Medicine in New Haven, Conn.

Surgery within six weeks of diagnosis is the recommended time frame, although no formal schedule exists, according to background notes in the study. Timing is important, because the earlier a cancer is treated, the better the odds for successful results. Also, long waits to surgery can be anxiety-provoking, the authors said.

The delays were more common than expected, Lott said.

Still, "these results are somewhat encouraging," he added. "Close to three-quarters are getting surgery within six weeks."

Delays were least common for patients whose melanoma was biopsied and excised by a dermatologist, compared to other physicians, Lott found. However, he said the message from this finding should not be to only see a dermatologist for melanoma care.

Once diagnosed, most people want a melanoma removed right away, one expert said.

"They want to leave the office without having it," said Dr. Martin Weinstock, professor of dermatology and epidemiology at Brown University in Providence, R.I.

"If we are really doing well, all would be having surgery within six weeks. But it's the real world," said Weinstock, who wasn't involved in the study.

Weinstock said it's not clear from the study what's causing the surgical delays.

Surgery might have been delayed in some cases for reasons other than scheduling backups, he said. Given the patients' ages -- most were 75 or older -- they could have had other major health conditions that needed to be treated first, he pointed out.

However, "anyone waiting for months to have a melanoma [taken] off is probably waiting too long," Weinstock said.

This year, about 74,000 new cases of melanoma are expected and about 9,900 deaths from the skin cancer, the American Cancer Society estimates. A warning sign is a change in color, shape or size of a spot or mole on the skin.

The average age of diagnosis is 62, the cancer society says.

For the study, published online April 8 in JAMA Dermatology, Lott's team looked at Medicare data on patients diagnosed with melanoma by a skin biopsy from 2000 through 2009 and the time that elapsed before the tumor was removed.

It's difficult to pinpoint when a melanoma has a higher chance of spreading, said Dr. Jerry Brewer of the Mayo Clinic, co-author of an accompanying commentary.

"Every tumor is a little different," he said. "What we do know is that melanoma can be a dangerous cancer that can spread and kill, with that outcome being more likely in thick tumors at the time of biopsy."

His advice for patients? You can ask for expedited appointments, Brewer said.

Weinstock said time is of the essence. "If you are diagnosed, get it surgically removed as soon as possible," he said. He added he would not recommend waiting around for months to see a specialist if another qualified doctor can do the surgery.

More information

To learn more about melanoma, see the Melanoma Research Foundation.

SOURCES: Jason Lott, M.D., dermatologist, former fellow in dermatology, Yale University, New Haven, Conn.; Martin Weinstock, M.D., Ph.D., professor, dermatology and epidemiology, Brown University, Providence, R.I.; Jerry Brewer, M.D., Mayo Clinic, Rochester, Minn.; April 8, 2015, JAMA Dermatology, online

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