Characteristics of 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database

Abstract

Background and Objective: Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined.Patients and Methods: Six hundred and thirtyseven melanomas treated by 27 Australasian GPs during 2013 and documented on the Skin Cancer Audit Research Database (SCARD) were analysed by anatomical site, subtype, Breslow thickness, diameter, associated naevi and linked adverse outcomes.Results: Most melanomas (59.7%) were on males, mean age at diagnosis being 62.7 years (range 18-96). Most (65.0%) were in situ, with a high incidence of lentiginous melanoma (LM) (38.8%) and 32% were naevus associated. Most LM (86.4%) were in situ, compared to 55% of superficial spreading melanoma (SSM) (P < 0.0001). There was male predominance on the head, neck and trunk and female predominance on extremities. There was no significant association between Breslow thickness and diameter, with small melanomas as likely to be thick as large melanomas, and melanomas ≤3 mm diameter, on average, more likely to be invasive than larger melanomas. There was a positive correlation between age and both melanoma diameter and Breslow thickness. Seven cases progressed to melanomaspecific death: Five nodular melanoma (NM) and two SSM, one of which was thin (Breslow thickness 0.5 mm).Conclusions: A large series of melanomas treated by Australasian GPs were predominantly in situ, with a high proportion of LM subtype. With implications for GP training, NM linked to death was overrepresented and there was a novel finding that older patients had larger diameter melanomas.

Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database

“…Studies on melanoma demographics, diagnosis and management by GPs are limited, and the available evidence from Australasia suggests that while gender and age distribution of patients are similar to tertiary care‐based studies, the proportion of in situ and thin‐invasive melanomas is higher 7,14 . Comparing the current study of 589 patients, with a Brisbane, Queensland, primary care‐based study of 380 patients, 14 the proportion of males was similar at 58.9% vs 57.1% as was the mean age at diagnosis, of 60 years (range 18–96) vs 57 years (range 19–95).…”

“…SCARD was established in 2007 as a free, patient safety, lesion‐tracking, self‐audit and research tool for professionals managing skin malignancies 7 . Its functions and workflow have been described 8 .…”

“…Its functions and workflow have been described 8 . Over one million unique lesions from over 415 000 patients have been entered on SCARD by more than 1300 practitioners, the majority being GPs working in Australasia 7 …”

“…We invited GPs who guaranteed completeness of data during 2013, to participate in the study. Twenty‐seven consented, 24 from Australia and 3 from New Zealand, representing 18.6% of those on SCARD in 2013, who contributed 35.6% of the melanomas diagnosed that year 7 …”

“…In this retrospective, cross‐sectional study of 637 melanomas managed by 27 GPs in Australia and New Zealand in 2013, we have evaluated the characteristics of the 589 patients, the diagnostic and therapeutic management, and the related outcomes. The characteristics of the 637 melanomas in this study have been previously described 7 …”