Health-Care Delay in Malignant Melanoma: Various Pathways to Diagnosis and Treatment

We aimed to describe and compare patients diagnosed with malignant melanoma (MM), depending on their initial contact with care and with regard to age, sex, and MM type and thickness, and to explore pathways and time intervals (lead times) between clinics from the initial contact to diagnosis and treatment. The sample from northern Sweden was identified via the Swedish melanoma register. Data regarding pathways in health care were retrieved from patient records. In our unselected population of 71 people diagnosed with skin melanoma of SSM and NM types, 75% of patients were primarily treated by primary health-care centres (PHCs). The time interval (delay) from primary excision until registration of the histopathological assessment in the medical records was significantly longer in PHCs than in hospital-based and dermatological clinics (Derm). Thicker tumors were more common in the PHC group. Older patients waited longer times for wide excision. Most MM are excised rapidly at PHCs, but some patients may not be diagnosed and treated in time. Delay of registration of results from histopathological assessments within PHCs seems to be an important issue for future improvement. Exploring shortcomings in MM patients’ clinical pathways is important to improve the quality of care and patient safety. 1. Introduction Malignant melanoma (MM) incidence is increasing globally, and Sweden is among the top 10 countries in the world with regard to incidence [1]. During the last decade, MM has become the sixth most common form of cancer in Sweden [2]. MM is a skin cancer with fatal outcome, if not diagnosed and treated in time [3]. A critical point in the development of MM is the penetration of the dermal-epidermal basement membrane, which highly increases the risk for metastases [4]. The optimal way to cure MM is therefore early detection and excision. The reduction of both patient and doctor’s delay is of key importance for early diagnosis and clinical outcome of MM. One reason for delayed diagnosis relates to patients’ care-seeking patterns for suspected MM [5]. A review of the literature concerning patient delay highlights health beliefs, low sense of severity, and susceptibility related to melanoma as reasons for delayed care seeking. Other reasons are related to gender, age, and living conditions [5–7]. In the health-care organization, reasons for late diagnosis of cancer in general have been related to accessibility, difficulties and complexity in procedures of diagnosis and incorrect referrals [8–12]. Despite its importance, reasons for health-care and doctor’s