Background
Melanoma is an aggressive form of skin cancer with increasing incidence worldwide. Timely diagnosis and management are crucial for optimising outcomes in these patients. One critical aspect of management is the time interval between excisional biopsy and wide local excision (WLE). The Ministry of Health (MOH) Faster Cancer Pathway recommends treatment is initiated (i.e. WLE) within 62 days of referral(1).
This audit examines time to wide local excision between two groups. Patients are referred to plastic surgery with either an atypical lesion requiring biopsy or a community biopsy report with histological diagnosis of melanoma.
Methods
Retrospective audit of all melanoma WLE specimens from January 2022 to November 2023. Timestamps between referral, excision biopsy, specialist appointment and WLE were recorded and compared. Patient demographics, Breslow depth, melanoma subtype and operative details form the remainder of the dataset. Mann-Whitney U tests were used to compare median wait times.
Results
A total of 233 patients were included in this study. Referrals with biopsy proven melanoma comprised 67% (n=155) and the remainder were patients referred with an atypical lesion (n=78). After excluding Melanoma-In-Situ (MIS) the mean Breslow depth was 2.44. MIS was most commonly diagnosed subtype of melanoma (40%). Median time to WLE for patients being referred to plastic surgery with a biopsy proven melanoma to wide local excision was 49 days, compared to 68 days for patients referred without biopsy (p<0.00001). Compliance with the MOH target was 75% (n=174). Sentinel node biopsy was associated with a longer wait time to treatment 42.5 vs 64 days (p=<0.00124).
Conclusions
Patients who are referred without biopsy have a longer wait time to definitive WLE. This outcome supports mobilisation of funding into community based health care services to perform biopsies of atypical pigmented lesions.