Time to treatment for primary melanoma in an integrated healthcare system.

Abstract

e21577 Background: Delayed treatment intervention for primary melanoma may negatively impact prognosis. This study investigated the relationship between the time from diagnosis to treatment (TTT) and overall survival (OS) in a large cohort of patients with primary melanoma. Methods: We analyzed data from a cohort of primary melanoma patients, stratifying them into three groups based on their TTT: 0-29 days (early treatment),30-59 days (intermediate delay), and more than 60 days (significant delay). Overall Survival (OS) was assessed using Kaplan-Meier analysis, and differences in survival were visually represented. Results: A total of 14,570 patients were included. The majority of patients (84%, 12,265) received treatment within 30 days. The proportion of patients with intermediate and significant delays were 13% (1901) and 3% (404), respectively. The overall survival was 113 months when their TTT was less than 30 days, 105 months for TTT 30-60 days and 91 months for patients more than 60 days ( p<.001 ). However, further analysis revealed that the TTT > 60 days group was significantly enriched for aggressive clinicopathological features, including male sex, older age, non-Caucasian race, advanced stage at diagnosis, and high-risk histology/location. After adjusting for these potent prognostic factors in the multivariate model, the apparent association between TTT and OS was substantially attenuated, suggesting that the observed decreased OS in the delayed group primarily serves as a proxy for inherently aggressive tumor biology and patient characteristics (p<.001). Conclusions: A significant treatment delay (> 60 days) in our integrated system is associated with a raw reduction in OS. Crucially, this delay appears to be a surrogate marker for existing, aggressive clinicopathological factors, rather than an independent cause of decreased survival. This finding suggests that patient and tumor characteristics, rather than system-level TTT alone, may drive the observed survival differences.