Specialty Matters When It Comes to Melanoma
A study published recently in the Journal of the American Academy of Dermatology (JAAD) laid out an argument that specialty matters when it comes to melanoma diagnosis. Researchers found that patients who have an established dermatologist relationship are more likely to have an accurate diagnosis of melanoma in situ, particularly if it is a primary melanoma, and also to have thinner melanoma lesions at the time of diagnosis. Additionally, self-detected melanomas were found in situ for 59% of patients who had a regular dermatologist, as compared to only 37% for patients without an established dermatologist. Researchers concluded that “education obtained at the dermatology appointment may improve early self-detection of melanoma, and having an established dermatologist may facilitate earlier evaluation of concerning lesions.”
Not only that, last month at the American Academy of Dermatology Annual Meeting Dr. Lott of Yale University shared that melanoma excision delays were significantly less common when the diagnostician was a dermatology provider, rather than a non-dermatology provider.
Dr. Lott stated, “I am making the argument that specialty matters.”
Dr. Lott and his colleagues conducted a population-based study of treatment waiting times in more than 32,501 Medicare patients who had been diagnosed with melanoma from 2000 to 2009. The study examined factors contributing to a surgical delay in the United States, and gathered to examine the time between biopsy and surgical treatment. Dr. Lott stated, “If a primary care provider was doing the surgery – and many still do their own surgery – patients were 1.6 times more likely to have a delay of more than 1.5 months, and twice as likely to have a delay of more than 3 months.”
Furthermore, Dr. Lott noted, “Earlier treatment does matter,” and supported his point by expounding on a retrospective study conducted in the United Kingdom that was shown to positively impact melanoma survival: researchers examined 4,399 patients who were evaluated at a pigmented lesions clinic within 2 weeks of a primary care identification of a suspicious lesion.
In the 2 years before the “2 week” rule was mandated in the UK, patients waited up to 34 days for a referral, and up to 74 days for treatment. Consequently, the 5-year survival rate of melanoma patients diagnosed in the clinics was 62%. In contrast, Lott described that 96 melanomas were identified during the study period, and that 96% of those were treated within 2 weeks of the primary referral. As a result, 74% were excised on the day of the clinic visit, and the 5-year survival rate of these patients diagnosed with melanoma increased to 82% of patients – a 20% increase.
Image: UM Health System