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

Abstract

Background and objective General practitioners manage more melanomas than dermatologists or surgeons in Australia. Previously undescribed, the management and outcomes of melanoma patients treated by multiple Australasian general practitioners are examined. Methods The characteristics, management and outcomes of 589 melanoma patients, managed by 27 Australasian general practitioners and documented on the Skin Cancer Audit Research Database (SCARD), were analysed. Results Most patients (58.9%) were males with mean age at diagnosis of 62.7 years (range 18–96), and most melanomas were in situ or thin‐invasive. Patients aged under 40 years had fewer melanomas, but a higher proportion (the majority) were invasive, compared with older patients (P < 0.0001). Most (55.9%) melanomas were diagnosed following elliptical excision biopsy, the rate of unintended involved margins being eightfold higher for shave biopsies. Wide re‐excision was performed by the treating general practitioner for most (74.9%) melanomas, with thick melanomas preferentially referred to surgeons. The average Breslow thickness of invasive melanomas re‐excised by general practitioners was 0.67 mm compared with 1.99 mm for those referred to other specialists (P < 0.0001). Of 205 patients with invasive melanoma, 14 progressed to metastatic disease, 50% of these being associated with nodular melanoma. Nine patients progressed to melanoma‐specific death. The 5‐year survival rate for patients with invasive melanoma was 95.2% (95% CI: 91.2–98.5%). Conclusions Diagnostic and therapeutic management of a series of melanoma patients by Australasian general practitioners were closely aligned with current guidelines and 5‐year survival with respect to invasive melanoma was at least as favourable as national population‐based metrics.

The diagnosis and initial management of melanoma in Australia: findings from the prospective, population‐based QSkin study

“…Moreover, we confirmed each primary melanoma diagnosis and obtained the type of excision by referring to the corresponding QCR pathology report, reducing the potential for misclassification that could arise by relying on MBS reimbursement data alone. Our findings are also consistent with a recent analysis of Skin Cancer Audit Research Database (SCARD) data which found that 55.9% of melanomas diagnosed in primary care were diagnosed after elliptical excision biopsy, with 74.9% undergoing wide re‐excision by the treating general practitioner 20 …”

“…Our findings are also consistent with a recent analysis of Skin Cancer Audit Research Database (SCARD) data which found that 55.9% of melanomas diagnosed in primary care were diagnosed after elliptical excision biopsy, with 74.9% undergoing wide re-excision by the treating general practitioner. 20 While we found that the most frequent initial procedure was surgical excision, almost half of all melanomas were diagnosed following partial excision (shave or punch biopsy). Australian clinical practice guidelines for melanoma 8 recommend that skin lesions suspected to be melanoma be completely excised by excisional biopsy with a 2 mm margin.…”

Measuring the quality of skin cancer management in primary care: A scoping review

“…71,81,[88][89][90][91] Treatment processes Thirty-two articles examined treatment processes of care. Evaluations of excision performance and adequacy of GPs (88%) usually measured the proportion of skin cancers exc ised 17,28,34,62,76,[78][79][80][81][82][83][85][86][87][88][91][92][93] or the proportion of complete (vs. partial) excisions. 23,28,34,37,71,76,82,83,86,87,[91][92][93][94] Other surgical treatment procedures, such as curettage, were also examined, 46,66,69,71,73,87 as well as non-surgical treatment such as cryotherapy.…”

“…High-risk surveillance 69,73 Using the preventive effects of ultraviolet (UV) radiation protection and vitamin B6 on AK progression 69 Information on the hazards of occupational UV radiation and behaviour change recommendations for workers with occupational exposure to UV radiation 73 Diagnostic process Unassisted visual diagnosis 17,66,[68][69][70][71]75,76 Proportion of correct diagnoses of melanoma by physician (compared to dermatologist diagnosis as gold standard) 75 29 (63) Sensitivity and specificity for melanoma detection by dermatologists and GPs during clinical skin cancer screening 68 Diagnostic-tool assisted diagnosis 17,[59][60][61][62][63][64]69,70,77,78 Proportion of melanomas that were found with the aid of totalbody photography or sequential digital dermoscopy imaging 78 Odds ratio of correctly diagnosed lesions with a dermoscope versus without a dermoscope 62 Diagnostic biopsy performance 17,23,34,46,62,69,71,75,76,[79][80][81][82][83][84]…”

“…Pathology delays 71,81,88 Time interval (delays) from primary excision until registration of histopathological diagnosis in patients with melanoma 81 Referral delays 81,88 Referral lead time between primary care and university level care 88 Treatment delays 71,81,[88][89][90][91] Surgical delay of 1.5 months from biopsy to excision in patients with melanoma 89 Treatment process Excision performance and adequacy 17,23,25,28,34,37,46,62,66,68,69,[71][72][73]76,[78][79][80][81][82][83]85,87,88,[91][92][93][94] Proportion of excisions performed on skin lesions suspected of malignancy 17…”