Clinical pathways to diagnose melanoma: a population-based study

Abstract

To better understand the clinical diagnostic process for invasive melanoma in Queensland. Descriptive population-based study of Queensland residents (n=3772) aged 20-75 years diagnosed with invasive melanoma between January 2000 and December 2003. Information was obtained via telephone interview combined with pathology data from the Queensland Cancer Registry. About 85% of melanoma patients diagnosed in Queensland saw a general practitioner at least once during the process, most of these for the initial consultation. Almost one-fifth of patients (18.1%) saw a skin clinic doctor sometime through the diagnosis pathway; this proportion increased significantly over the study period (P<0.001). The most common pathway for diagnosing melanoma was an initial consultation by a general practitioner followed by referral to a surgeon for a definitive diagnosis. People living in southeast Queensland were more likely to see a dermatologist compared with those living in more rural or remote areas (14.7 versus 6.8%), more likely to see a skin clinic doctor (21.8 versus 7.2%), or a surgeon (54.9 versus 49.3%) at least once during the diagnostic process, and less likely to see a general practitioner (76.8 versus 90.2%). This descriptive study has demonstrated the complexity and diversity of clinical diagnostic pathways for melanoma in Queensland, highlighting the important role of general practitioners and the emerging role of primary care skin clinics. Although this system has resulted in a very favourable thickness distribution for diagnosed melanomas, access issues for people living in rural and remote areas of Queensland need to be addressed.

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

“…Despite its importance, reasons for health-care and doctor's delay in MM have been only sparsely investigated. Earlier studies emphasized difficulties in diagnostics [5, 13], as well as low access to general practitioners (GPs) [14], and gatekeeping [11]. Baade et al [13] have described the diagnostic process and highlighted the important role of GPs and the emerging role of primary care skin clinics.…”

“…Earlier studies emphasized difficulties in diagnostics [5, 13], as well as low access to general practitioners (GPs) [14], and gatekeeping [11]. Baade et al [13] have described the diagnostic process and highlighted the important role of GPs and the emerging role of primary care skin clinics. They also reported that older people from rural areas needed special attention and intervention since both patient delay and health-care delay are prolonged.…”

“…Only a few studies have described pathways and lead times between clinics from initial care seeking to diagnosis and treatment for MM [13, 14, 19]. The aim of this study was to describe and compare patients diagnosed with MM, depending on their initial contact with care, with regard to age, sex, and MM type and thickness, and to explore pathways and lead times between clinics from the initial contact to diagnosis and treatment.…”

Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection

“…In Queensland, Australia, less than 20% of patients with melanoma see a dermatologist at any point in their care, relying instead principally on primary care physicians and surgeons. 7 However, detection of melanoma by a dermatologist, compared with detection by a nondermatology trained physician, has been associated with earlier melanoma detection and decreased mortality, highlighting the hazards of simply expanding the pool of providers evaluating patients for melanoma. 8 Other strategies have focused on improving access to dermatologists, rather than increasing the total number of providers.…”

Doctors’ recognition and management of melanoma patients’ risk: An Australian population-based study

“…Several studies have described aspects of melanoma care in the Australian setting (18,19,22,(29)(30)(31)(32), or have measured compliance with clinical practice guidelines (21,(33)(34)(35)(36). However, to our knowledge our study is the first to report on doctors' knowledge of patients' risk factors and its relationship with subsequent skin-related follow-up advice and recommendations for melanoma in Australia.…”