title: Malignant melanoma: factors affecting the surgical interval from excision biopsy to definitive surgical management.
abstract: BACKGROUND
  Surgery remains the mainstay of treatment for malignant melanoma. Despite previous studies examining the surgical interval (SI) between the diagnostic excision biopsy (DEB) and definitive surgical management there remains few guidelines regarding an optimal time interval. The aim of this study was to determine the SI between DEB and definitive surgery and elucidate factors associated with delays in management of malignant melanoma.
  
  
  METHODS
  A retrospective study of 107 consecutive patients who had a DEB and subsequent wide local excision between January 2011 and June 2012 was performed. Mode of referral and dates of diagnostic biopsy/definitive surgery were documented. Patient demographics and tumour characteristics were reviewed.
  
  
  RESULTS
  The mean age was 59.6 years, and male:female ratio was 1:1.3. Median duration of the SI was 41 ± 27 days (range 6-137 days). The SI was increased when dermatologists performed the DEB as opposed to general surgeons (p = 0.035). The anatomic location of the lesion predicted the SI, with lesions of the head/neck undergoing definitive excision 48 ± 32.3 days after DEB vs. 37.5 ± 22.6 days for all other sites (p = 0.001). Neither demographic factors nor histopathological prognostic features affected the SI. Reasons for a prolonged SI included referrals to different services and time for pre-operative planning.
  
  
  CONCLUSIONS
  Significant variations were noted in the SI predominantly accounted for by mode of referral and location of the malignant melanoma. Further investigation is required to elucidate factors affecting the SI and its subsequent effect on patient outcomes.
authors.affiliation: Departments of General Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland, mickyboland@gmail.com.
authors.forename: M R
authors.initials: MR
authors.lastname: Boland
authors.forename: R S
authors.initials: RS
authors.lastname: Prichard
authors.forename: G A
authors.initials: GA
authors.lastname: Bass
authors.forename: Z
authors.initials: Z
authors.lastname: Al-Hilli
authors.forename: A
authors.initials: A
authors.lastname: Levendale
authors.forename: D
authors.initials: D
authors.lastname: Gibbons
authors.forename: K
authors.initials: K
authors.lastname: Sheahan
authors.forename: B
authors.initials: B
authors.lastname: Kirby
authors.forename: E W
authors.initials: EW
authors.lastname: McDermott
authors.forename: D
authors.initials: D
authors.lastname: Evoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D061665:Time-to-Treatment; D055815:Young Adult