Outcomes in Melanoma Patients With Delayed Excision Following Diagnostic Biopsy: A Systematic Review and Analysis of the Last Two Decades

Timely wide local excision (WLE) following diagnostic biopsy is a cornerstone of melanoma management and is critical for optimizing oncologic outcomes. However, real-world delays due to referral bottlenecks, limited surgical availability, and systemic healthcare disparities are common and may impact prognosis. This systematic review evaluated the clinical implications of delayed excision-typically defined as occurring more than 30 days after biopsy-in patients with Stage 0-III cutaneous melanoma. A comprehensive search of PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library from 2004 to 2024 identified 21 eligible studies that met predefined inclusion criteria. The majority of studies demonstrated that surgical delays beyond 30 to 60 days were associated with increased recurrence rates, reduced disease-free survival (DFS), and lower overall survival (OS), particularly in patients with intermediate-thickness and thick melanomas. Sentinel lymph node positivity and inadequate surgical margins were also more frequent in delayed groups, suggesting both biological progression and technical challenges. These associations remained consistent across diverse study designs, including national registries and institutional cohorts, despite heterogeneity in patient populations and definitions of delay. Additionally, psychosocial stress, racial disparities, insurance status, and geographic barriers emerged as important contributors to excision delay and oncologic outcomes. Taken together, the findings underscore the prognostic importance of timely surgical management and support the need for system-level interventions aimed at minimizing delays and improving equitable access to definitive melanoma treatment.