Surgical Delays of 91 Days or More Linked to Worse Outcomes in Early-Stage Vulvar Melanoma

A study published in the *Journal of the American Academy of Dermatology* found that delays in surgical treatment of 91 days or longer after a diagnostic biopsy for early-stage vulvar melanoma were associated with higher odds of positive surgical margins and worse long-term overall survival, according to researchers from the Mayo Clinic.

What Is the Impact of Delayed Surgery on Vulvar Melanoma Outcomes?

The retrospective cohort study analyzed data from 1,857 patients with stage I-II vulvar melanoma in the National Cancer Database, spanning from 2004 to 2022. Patients were categorized by time to treatment initiation (TTI): 30 days or less, 31 to 59 days, 60 to 90 days, and 91 days or longer. Results showed that 15.9% of patients had positive surgical margins, with those experiencing delays of 91 days or more having 1.725 times higher odds of margin positivity compared to those treated within 30 days (adjusted odds ratio [aOR], 1.725; P = .015).

While TTI was not linked to overall survival (OS) during the first 36 months, delays of 91 days or more were associated with higher mortality beyond that period (adjusted hazard ratio [aHR], 1.583; P = .011). The study also noted that longer delays were more common in recent years and among non-White patients, who often had higher comorbidity burdens.

Why Does This Study Matter for Clinical Practice?

The findings underscore the importance of timely surgical intervention for early-stage vulvar melanoma, a rare but aggressive cancer. “Prolonged surgical delays (≥ 91 days) are associated with higher odds of positive margins and worse long-term OS,” the authors wrote, emphasizing the need for further investigation into systemic barriers to care. The study highlights a “temporal trend” in delayed treatments, which may reflect broader challenges in accessing care for vulnerable populations.

“These observations highlight the potential clinical importance of timely definitive surgical treatment,” the researchers added, calling for strategies to reduce delays and improve outcomes.

What Are the Limitations of This Research?

The study’s retrospective design limited its ability to account for factors like biopsy details, surgical techniques, or reasons for delays. Additionally, data on melanoma-specific survival and recurrence were unavailable. The cohort was predominantly White (94%), raising questions about generalizability to more diverse populations.

“The lack of melanoma-specific survival data is a critical gap,” said Dr. Hue T.T. Tran, lead author and dermatologist at the Mayo Clinic. “Future studies should prioritize longitudinal tracking of recurrence and mortality to better inform treatment guidelines.”

How Can Patients and Providers Respond?

For patients, the study reinforces the need to address delays in scheduling surgery, particularly for those facing socioeconomic or logistical barriers. Providers are advised to monitor TTI and consider alternative approaches for patients with prolonged wait times. The findings also call for policy interventions to reduce disparities in access to care.

“Timely treatment isn’t just a medical priority—it’s a matter of survival,” said Dr. Tran. “Understanding and mitigating the factors behind these delays is crucial for improving outcomes.”