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

Autor: Hay J; Upper Hutt Skin Clinic, Upper Hutt, Wellington, New Zealand., Keir J; General Practice Clinical Unit, Medical School, The University of Queensland, Australia., Jimenez Balcells C; 4D Skin Cancer Clinic, Belmont North, New South Wales, Australia., Rosendahl N; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia., Coetzer-Botha M; General Practice Clinical Unit, Medical School, The University of Queensland, Australia., Wilson T; SCARD, Brisbane, Queensland, Australia., Clark S; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Tehran University of Medical Sciences, Tehran, Iran., Baade A; Gladstone GP Superclinic, Gladstone, Queensland, Australia., Becker C; Wairarapa Skin Clinic, Masterton, New Zealand.; Wairarapa Hospital, Lansdowne, Masterton, New Zealand., Bookallil L; The University of New England, Armidale, New South Wales, Australia., Clifopoulos C; General Practice Clinical Unit, Medical School, The University of Queensland, Australia., Dicker T; General Practice Clinical Unit, Medical School, The University of Queensland, Australia., Denby MP; Silverdale Medical, Silverdale, Auckland, New Zealand., Duthie D; Darwin Skin Cancer Clinic, Parap, Northwest Territories, Australia., Elliott C; Solarderm Skin Cancer Practice, Caboolture, Queensland, Australia., Fishburn P; General Practice Clinical Unit, Medical School, The University of Queensland, Australia., Foley M; The Skin Clinic, Marlborough - Blenheim, New Zealand., Franck M; MoleSafe Skin Cancer Clinic, Windsor, Victoria, Australia., Giam I; Skin2 Clinic, Deakin, Australian Capital Territory, Australia., Gordillo P; Cairns Skin Cancer Clinic, Cairns, Queensland, Australia., Lilleyman A; Newcastle Skin Check, Charlestown, New South Wales, Australia., Macauley R; Bateau Bay Medical Centre, Bateau Bay, New South Wales, Australia., Maher J; Skin Cancer Ballarat, Alfredton, Victoria, Australia., McPhee E; Emerald Medical Group, Emerald, Queensland, Australia., Reid M; Nelson Bay Skin Cancer Clinic, Nelson Bay, New South Wales, Australia., Shirlaw B; Lakeside Medical, Springfield Lakes, Queensland, Australia., Siggs G; Regency Medical Clinic, Sefton Park, South Australia, Australia., Spark R; Toukley Family Practice, Toukley, New South Wales, Australia., Stretch J; Bond University, Robina, Queensland, Australia., van Den Heever K; CQ Skin Cancer Clinic, Bucasia, Queensland, Australia., van Rensburg T; Kippax Ochre Medical Centre, Holt, Australian Capital Territory, Australia., Watson C; Brisbane City Doctors, Brisbane, Queensland, Australia., Kittler H; Vienna Dermatologic Imaging Research Group, Department of Dermatology, Medical University of Vienna, Vienna, Austria., Rosendahl C; General Practice Clinical Unit, Medical School, The University of Queensland, Australia.; Tehran University of Medical Sciences, Tehran, Iran.
Jazyk: angličtina
Zdroj: The Australasian journal of dermatology [Australas J Dermatol] 2022 May; Vol. 63 (2), pp. 204-212. Date of Electronic Publication: 2022 Apr 19.
DOI: 10.1111/ajd.13843
Abstrakt: 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.
(© 2022 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)
Databáze: MEDLINE
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