Timing of Melanoma Diagnosis, Treatment Can Mean Life or Death

The sooner melanoma patients are treated, the better their survival, particularly for stage I melanoma, according to a new study from the Cleveland Clinic.

The research appears online today in the Journal of the American Academy of Dermatology.

Using the National Cancer Database, researchers from Cleveland Clinic’s Dermatology & Plastic Surgery Institute studied 153,218 adult patients diagnosed with stage I-III melanoma from 2004 to 2012 and found that overall survival decreased in patients waiting longer than 90 days for surgical treatment, regardless of stage. In addition, the delay of surgery beyond the first 29 days negatively impacted overall survival for stage I melanoma, though not for stage II or III.

Compared to patients who were treated within 30 days, patients with stage I melanoma were 5 percent more likely to die when treated between 30 and 59 days; 16 percent more likely to die when treated between 60 and 89 days; 29 percent more likely to die when treated between 91 and 120 days; and 41 percent more likely to die when treated after 120 days. Patients with a longer time to treatment initiation tended to be older and male, and have more comorbidities, the study showed.

According to the authors, it is likely that more advanced cases represent delays in diagnosis, and these delays overwhelm the impact of a speedier treatment. However, in early stage cases, early diagnosis allows for the opportunity to improve the chances of survival with a prompt surgery. Although many physicians follow a rule-of-thumb to treat melanoma surgically three to four weeks after diagnosis, there is no official recommendation on time to treatment.

“The ideal timing for melanoma treatment, predominantly surgery, had yet to be determined – until now,” says Brian Gastman, M.D., a plastic surgeon, director of melanoma surgery at Cleveland Clinic, and the primary investigator on the study, in a news release. “Patients and referring physicians are not only concerned with how a melanoma is removed, but also when it’s removed. We saw significantly worse prognoses and outcomes for those surgically treated after 30 days of stage I melanoma diagnosis. Knowing for certain that a more expedient time to surgery to remove an early melanoma improves the chances of survival is a game-changer in treating this life-threatening skin cancer.”

Because many physicians may be involved in the treatment of stage I melanoma –including general practitioners, dermatologists, general surgeons, surgical oncologists and plastic surgeons, among others – it’s important for the entire medical community to be aware of the danger of melanoma and provide prompt treatment. In addition, patients should be prepared to be their own health advocates to prevent delays in their treatment.