Is initial excision of cutaneous melanoma by General Practitioners (GPs) dangerous? Comparing patient outcomes following excision of melanoma by GPs or in hospital using national datasets and meta-analysis

Murchie, Peter; Raja, Edwin Amalraj; Brewster, David H.; Iversen, Lisa

doi:10.1016/j.ejca.2017.09.034

Cited by 17 publications

(15 citation statements)

References 25 publications

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“…Teledermatology not only allows clinicians rapid access to expert opinion but may lead to a reduction in waiting times and limit unnecessary referrals (Ndegwa 2010;Warshaw 2010;Bashshur 2015). In rural areas, where people's access to speciality services can have significant and potentially o -putting travel and time implications, teledermatology has the potential to increase access to specialist opinion.…”

Section: Alternative Test(s)mentioning

confidence: 99%

Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma

Chuchu

Takwoingi

Dinnes

et al. 2018

Cochrane Database of Systematic Reviews

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Across the four artificial intelligence-based applications that classified lesion images (photographs) as either melanomas (one application) or as high risk or 'problematic' lesions (three applications), sensitivities ranged from 7% (95% CI 2% to 16%) to 73% (95% CI 52% to 88%) and specificities from 37% (95% Cochrane Library Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma (Review)

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Section: Alternative Test(s)mentioning

confidence: 99%

Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma

Chuchu

Takwoingi

Dinnes

et al. 2018

Cochrane Database of Systematic Reviews

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“…In the UK, for example, current guidelines explicitly discourage [4][5][6] GP involvement in the management of patients with melanoma other than the making of an initial visual diagnosis. 7 According to the current UK guidelines, all patients who present with a lesion that the GP suspects to be a melanoma should be referred to secondary care for diagnosis and treatment. [4][5][6] In addition, current European guidelines do not make any recommendations about which health professionals should biopsy suspicious skin lesions.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 However, given the increasing incidence of melanoma in many countries around the world, 10,11 including the UK, and the lack of specialists to meet this increasing demand, some have argued there is a benefit in learning from Australia's experience in melanoma management, in particular GPs' involvement in melanoma diagnosis and care. 7 Australia has the highest incidence of melanoma in the world 10 and it is the most frequently occurring cancer among younger Australian adults. 12 Public health campaigns and professional education initiatives have alerted the Australian public and GPs to the importance of melanoma prevention and early detection.…”

Section: Introductionmentioning

confidence: 99%

GPs’ involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study

et al. 2020

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Background: In Australia, melanoma is managed in primary and secondary care settings. An individual concerned about a suspicious lesion typically presents first to their GP.Aim: To identify factors influencing GPs' decisions to diagnose, treat, or refer patients with suspected melanoma.Design & setting: Semi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia. Method:The semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data.Results: Considerable variation existed in GPs' self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs' decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP's clinical interests, Smith AL et al.the clinical features (for example, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management.Conclusion: GP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate. How this fits inIn Australia, melanoma can potentially be diagnosed and treated wholly within the primary care setting, yet little is known about how GPs decide how involved they wish to be in melanoma management. This qualitative interview study reveals the diversity of GP engagement in melanoma management and highlights how GPs' involvement can extend well beyond prevention, early detection, and supportive care to include provision of definitive melanoma management. The study identifies multiple factors influencing a GP's decision to treat or refer a patient with melanoma. The findings indicate that more attention should be given to GPs' involvement in melanoma management, in particular to how GPs can be further supported to deliver optimal melanoma care.

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“…[7][8][9] Recently, however, reassuring evidence was found in a whole-Scotland sample of 9519 people diagnosed and treated for melanoma from 2005 to 2013, which showed that primary care excision of melanoma does not result in increased mortality and morbidity. 10 In the earlier work by the authors of this study, despite observing higher rates of initial excision of melanoma by GPs,. no evidence was found of rural patients in Northeast Scotland having higher rates of incomplete excision, nor did they have increased rates of morbidity or mortality.…”

Section: Introductionmentioning

confidence: 58%

Impact of rurality on processes and outcomes in melanoma care: results from a whole-Scotland melanoma cohort in primary and secondary care

et al. 2018

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Patients in Scottish rural locations were more likely to have a melanoma excised in primary care. However, those in rural areas did not have significantly increased mortality from melanoma. Together these findings suggest that current UK melanoma management guidelines could be revised to be more realistic by recognising the role of primary care in the prompt diagnosis and treatment of those in rural locations.

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Is initial excision of cutaneous melanoma by General Practitioners (GPs) dangerous? Comparing patient outcomes following excision of melanoma by GPs or in hospital using national datasets and meta-analysis

Cited by 17 publications

References 25 publications

Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma

Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma

GPs’ involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study

Impact of rurality on processes and outcomes in melanoma care: results from a whole-Scotland melanoma cohort in primary and secondary care

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