Delays in the referral and primary management of cutaneous malignant melanoma at Tygerberg Hospital

Abstract

Background: Cutaneous malignant melanoma (CMM) is a significant cause of skin cancer-related mortality. The time between the diagnostic biopsy and primary surgical excision, the surgical interval (SI), is a modifiable factor that may impact melanoma outcomes. Delays in the SI are attributable to many factors. Aim: To determine the SI in patients with resectable CMM treated at Tygerberg Academic Hospital (TAH). Methods: A retrospective review of patients referred to the TAH multidisciplinary melanoma clinic with histologically confirmed CMM between January 2015 and December 2017 was done. Patients 18 years with resectable melanoma (T1b-T4b N0-3 M0-1a) who received definitive surgery were included. Results: The cohort (n = 40) comprised mostly Caucasians referred from the Cape metropolitan (metro) area, with a median age at diagnosis of 59 years. Thirty-one (77.5%) patients had T3 or T4 lesions on diagnostic biopsy. Twenty patients (50%) underwent a sentinel lymph node biopsy (SLNB) which led to an upstaging in 20% of cases. The median length of the SI was 13.5 weeks. Eighteen patients (45%) underwent primary excision within the recommended 12 weeks from diagnostic biopsy. There was a significant association between the SI and patients living in the Cape metro (p = 0.04) as well as the SI and p Stage (p = 0.01). Conclusion: Surgical interval guidelines for cutaneous melanoma are poorly defined. We used 12 weeks as an extrapolation of international guidelines. Even though this target was not met, the study is proposed to be of value in guiding future protocols and ultimately allowing for improved, timely service to patients.

Keywords

• surgical interval
• melanoma
• biopsy
• delay
• skin cancer