Patient diagnosed with melanoma waiting 3 weeks for removal

[BayPAC]

Patient diagnosed with melanoma, confirmed by biopsy, now needs to wait 3 weeks for surgery due to surgeon availability. Isn't 3 weeks too long? 

[lkth487]

No.  If I remember correctly, the recommendation is 4-6 weeks but even longer times have not been associated with poorer survival.  Get them in as soon as you can, but I do not believe a 3 week timeframe has been shown to be dangerous.

 

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/12100184

https://www.ncbi.nlm.nih.gov/pubmed/19095097

[CAdamsPAC]

Only one physician in the area that can perform the excision?

 

[Cideous]

and if the person with Melanoma was your child.........?

 

Heaven and Earth.........Heaven and Earth...............

[lkth487]

19 minutes ago, Cideous said:

and if the person with Melanoma was your child.........?

I'd want it done in the next five minutes.  But that's not the point is it? If it was my kid,  I'd love for everything to happen immediately, from that MRI for a MSK injury to the dermatologist appointment for eczema.   I might want my kid to be the priority in the ED for a cold compared to someone else who has a head bleed.  But as a provider, your job is to decide on the priorities of things since all things can't be done immediately with the resources that are available.

Obviously there is a lot of patient anxiety with having to live with a known melanoma and you should expedite the removal as much as you can - hence my point about getting them in as soon as possible.  But from a medical perspective, the evidence shows that it doesn't seem likely that you will have a worse outcome if you have to wait three weeks.  If I was the surgeon, and I was booked, I may try to see if I can fit this in earlier, but I wouldn't necessarily move heaven or earth (e.g put off someone else's surgery) in the absence of other medical factors that would necessitate an earlier removal.

But this is not my field and I'm happy to be corrected if anyone can find some evidence to the contrary.

[PA-C]

I and the other derm providers I work with recommend that our melanoma patients have the lesion excised within 1 month of biopsy. Obviously the sooner the better, but having an excision within 3 weeks of original biopsy is reasonable based on information from recent medical literature.

Compared with Stage I melanoma patients treated within 30 days of being biopsied, those being treated 30 to 59 days after biopsy have a 5% higher risk of dying of melanoma and those treated more than 119 days after the biopsy have a 41 percent increased risk.

Source Skin Cancer Foundation quoting Conic et al in JAAD 2018; 78(1)

[CAAdmission]

18 hours ago, PA-C said:

Compared with Stage I melanoma patients treated within 30 days of being biopsied, those being treated 30 to 59 days after biopsy have a 5% higher risk of dying of melanoma and those treated more than 119 days after the biopsy have a 41 percent increased risk.

That's kinda like saying go get in the closet and shut the door and I am going to fire a gun through the door. There's only around a 5 percent chance I'll kill you.

[lkth487]

Was it 5% higher than <30 days, or 5% higher overall?   The former may not be all that significant clinically given all the other factors involved.  If you're talking about the chance of death going from 10% to 10.5% - it may not be significant given the limitations of the study (retrospective, not much standardization given use of a national database, etc), vs going from 5% to 10%, which is likely significant.

[Cideous]

11 hours ago, CJAdmission said:

That's kinda like saying go get in the closet and shut the door and I am going to fire a gun through the door. There's only around a 5 percent chance I'll kill you.

Exactly what I was thinking.  Just unacceptable.

[ventana]

I still remember the first patient I dx CA on

I was amazed at how SLOWLY everything happened....

 

it is just the way it works....