Quality assurance in melanoma care: The EU-MELACARE study

Sommariva, Antonio; Forsea, Ana Maria; Agius, Domenic; Ascierto, Paolo A.; Bastiaannet, E.; Borgognoni, Lorenzo; Demetriou, Anna; Garbe, Claus; Gavrić, Živana; Hočevar, Marko; Innos, Kaire; Larønningen, Siri; Louwman, Marieke W. J.; Robsahm, Trude Eid; Rutkwoski, Piotr; Akkooi, Alexander C. J. van; Zorzi, Manuel; Pasquali, Sandro; Velde, Cornelis van de; Róssi, Carlo

doi:10.1016/j.ejso.2018.06.020

Cited by 4 publications

(6 citation statements)

References 22 publications

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“…In addition, in terms of national differences, we found that among 204 countries, the top five countries with the highest ASDR and ASR of DALYs in 2019 were New Zealand, Australia, Norway, Sweden and the Netherlands, which was consistent with the GBD 2015 estimates [7] . Considering the global burden of melanoma (incidence, death, and DALYs), Europe was one of the most affected places in the world [27] , as our study found that Norway, Sweden and Netherlands were in the top five ASDR and ASR of DALYs for melanoma. Moreover, in addition to New Zealand and Australia, there are three European countries in the top five ASIR countries: Netherlands, Norway and Denmark.…”

Section: Discussionmentioning

confidence: 57%

Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study

Fang

Chen

et al. 2022

Neoplasia

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This study aimed to estimate the latest magnitudes and temporal trends of melanoma burden at the national, regional, and global levels. The data on melanoma incidence, deaths, and disability-adjusted life-years (DALYs) in 204 countries and territories between 1990 and 2019 came from the Global Burden of Disease 2019 Study. Estimated annual percentage change (EAPC) was calculated to depict the temporal trends and Spearman rank correlation was used to analyze the influential factors of EAPC. From 1990 to 2019, the incident cases of melanoma increased by 170% to 289,950, death increased by 90% to 62,840, and DALYs increased by 67% to 1,707,800 globally. The age-standardized incidence rate (ASIR) of melanoma increased globally by an average of 1.13 [95% confidence interval (CI): 0.93–1.32], while the age-standardized rates of death and DALYs both declined with the EAPC of −0.27 (95% CI: −0.36 to −0.19) and −0.49 (95% CI: −0.57 to −0.41). In 2019, the highest burden of melanoma was observed in Australasia, followed by high-income North America and Europe regions, which all presented an incremental growth in ASIR. The positive association between the EAPC in ASIR and socio-demographic index (SDI) in 2019 ( ρ = 0.600, P < 0.001) suggested that countries with higher SDI have experienced a more rapid increase in ASIR of melanoma. In conclusion, the burden of melanoma is increasing globally but differed greatly across the world. Notably, the high burden areas are facing a continuing increase in incidence, which implies more targeted strategies should be taken for reducing the increasing melanoma burden.

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Section: Discussionmentioning

confidence: 57%

Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study

Fang

Chen

et al. 2022

Neoplasia

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“…We are not aware of data that examines the impact of melanoma clinical quality registries on patient outcomes; however, such registries have been attributed to improved outcomes in other cancers. 4,23 For example, the implementation of quality indicators in the Danish Lung Cancer Registry and Manchester Polyposis Registry for colorectal cancer were associated with an improvement in patient survival. 24,25 While our clinical quality indicators were rated as feasible to collect, collecting the required data from the many relevant entities involved will be a challenge, compounded by the disparate locations and medical workforce involved in treating primary cutaneous melanoma in Australia including independent primary care clinics.…”

Section: Discussionmentioning

confidence: 99%

Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study

Jobson

Roffey

Arnold³

et al. 2022

Aust J Dermatology

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Background Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty‐six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. Methods Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two‐round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. Results Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. Conclusion This study provides a multi‐stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).

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“…However, Marushchak et al suggested that the high cost of screening and potentially increased rates of lesion excisions, as well as overimaging and overtreating, pose serious concerns [31]. The integration of RCM in the diagnostic patient pathway improves diagnostic power for melanoma detection through the addition of morphologic clues, thereby reducing unnecessary excisions compared to dermoscopy [20]. The increased precision in melanoma detection in this study compares very favorably with estimates from dermatologists around the world, ranging from 12 to 16% [29].…”

Section: Discussionmentioning

confidence: 99%

“…Historical data for the same region previously estimated an incidence of melanoma over the period 1997-2004 of 9.7 for invasive melanoma only and 11.9, including in situ melanoma [26]. In the province, various prevention programs and a systematic diagnostic-therapeutical workflow were implemented, including: (i) "Skin Cancer Day" from 1999, to heighten patient awareness and encourage contact with dermatology specialists; (ii) the Provincial Regulatory document, approved in July 2013, enabling direct access for all patients with suspicious lesions referred by primary care physicians to same-day dermatological specialist services at DP; (iii) annual obligatory continuous education programs for primary care physicians from 2013 to 2016; and (iv) the integration of high-performance technology of RCM in DP in the diagnostic workflow in 2013 to enhance both sensitivity and specificity of atypical lesions assessment and the patient pathway for more immediate in vivo diagnostics [20].…”

Section: Methodsmentioning

confidence: 99%

“…However, a consistent burden to health services remains, and estimates depend upon medical expertise and available diagnostic tools [19]. Some specialized centers have adopted reflectance confocal microscopy (RCM), non-invasive cytological imaging of the skin, which enables the containment of this surgical burden through an excellent sensitivity and specificity compared to histology [19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous Melanoma Systematic Diagnostic Workflows and Integrated Reflectance Confocal Microscopy Assessed with a Retrospective, Comparative Longitudinal (2009–2018) Study

Pellacani

Farnetani

Chester

et al. 2022

Cancers

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Background: The increasing global burden of melanoma demands efficient health services. Accurate early melanoma diagnosis improves prognosis. Objectives: To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and high-performance technology integration) and estimate cost savings. Methods: Retrospective analysis of epidemiological data of an entire province over a 10-year period of all excised lesions suspicious for melanoma (melanoma or benign), registered according to excision location: reference hospital (DP) or other (NDP). A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Impact was assessed with the number of lesions needed to excise (NNE). Results: From 40,832 suspicious lesions excised, 7.5% (n = 3054) were melanoma. There was a 279% increase in the number of melanomas excised (n = 203 (2009) to n = 567 (2018)). Identification precision improved more than 100% (5.1% in 2009 to 12.0% in 2018). After RCM implementation, NNE decreased almost 3-fold at DP and by half at NDP. Overall NNE for DP was significantly lower (NNE = 8) than for NDP (NNE = 20), p < 0.001. Cost savings amounted to EUR 1,476,392.00. Conclusions: Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma. Total costs may be reduced by as much as 37%.

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Quality assurance in melanoma care: The EU-MELACARE study

Cited by 4 publications

References 22 publications

Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study

Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study

Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study

Cutaneous Melanoma Systematic Diagnostic Workflows and Integrated Reflectance Confocal Microscopy Assessed with a Retrospective, Comparative Longitudinal (2009–2018) Study

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