Editor’s note: this article was updated to fix a typo in the journal title.

Several factors including insurance status, ethnicity, and stage at diagnosis are associated with delayed treatment for patients with melanoma, according to a study published in JAMA Dermatology.1

It was previously shown that beneficiaries of Medicare and Medicaid are more likely to experience melanoma treatment delays, defined as longer than 1.5 months from diagnosis to surgery. For this retrospective analysis, researchers evaluated data from 7629 patients with melanoma included in the North Carolina cancer registry to determine factors associated with delayed treatment.

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All cases were diagnosed between 2004 and 2011. The mean age was 64 — a younger average than seen in previous studies on this subject — and 98% of patients were non-Hispanic Caucasians. Most patients were insured privately or through Medicare (48% each), while 4% of patients were covered by Medicaid.

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Nearly a quarter (24%; 79) of patients covered by Medicaid had delays in surgery vs 17% and 14% of patients insured through Medicare and privately, respectively.

After adjusting for risk predictors, analyses showed that non-Caucasian patients (risk ratio [RR], 0.83), patients insured through Medicare (RR, 0.94) or Medicaid (RR, 0.72), and patients diagnosed with stage I (RR, 0.92), stage II (RR, 0.73), or stage III (RR, 0.73) disease were more likely to experience delays of longer than 1.5 months (references were Caucasian background, private insurance, and stage 0 disease, respectively).

Patients diagnosed by dermatologists were also less likely to have treatment delays.

The authors concluded that “[e]ither the suggested 6-week period between biopsy and excision is a flawed measure of quality, or the health care system is systematically failing to deliver high-quality care to a substantial proportion of patients with melanoma in general.”


  1. Adamson AS, Zhou L, Baggett CD, Thomas NE, Meyer AM. Association of delays in surgery for melanoma with insurance type. JAMA Dermatol. 2017 Oct 4. doi: 10.1001/jamadermatol.2017.3338 [Epub ahead of print]