Diagnostic challenges and the critical role of early multidisciplinary management of acral melanoma

Background:The incidence of cutaneous melanoma is still high in many countries.Diagnosis at an early stage carries a favorable prognosis and the time from first doctor's visit to excision is therefore vital.The aim of this study was to elucidate determinants associated to a doctor's delay in melanoma diagnosis.Methods: A questionnaire was allocated to patients with histologically confirmed melanoma in situ and invasive melanomas between 2018-2020 in Southern Sweden.The questionnaire included questions relating to patient demographics and patient's and doctor's delay.Clinical and histopathological data for the invasive melanomas was retrieved from the Swedish quality registry for cutaneous melanoma (SweMR).Doctor's delay was divided into three groups, <30 days (mild delay), 30-90 days (moderate delay) and >90 days (severe delay).Univariable and multivariable multinominal logistic regression analysis were used to estimate the association between potential risk factors and doctor's delay.Results: The study included 2207 patients (1105 female and 1102 male), 1001 patients had melanoma in situ and 1206 invasive melanoma.Risk factors associated to a severe doctor's delay (>90 days) included age >75 years (RR: 2.74, CI: 1.27-5.89)and a positive family history of melanoma (RR: 2.09, CI: 1.20-3.62).A significant reduced risk of a severe delay was Breslow thickness between 1.1-2.0(RR: 0.39, CI: 0.20-0.74)and 2.1-4.0 mm (RR: 0.24, CI: 0.09-0.62)and moderate delay (30-90 days) if the first visited doctor was a dermatologist compared to a general practitioner (RR: 0.39, CI: 0.26-0.59).Conclusions: Several risk factors for a doctor's delay of melanoma diagnosis were identified.To mitigate the effect of doctor's delay, focus should be on education of primary care physicians and facilitate a dermatologist's assessment e.g. by teledermatoscopy.