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Dessinioti C, Plaka M, Befon A, Polidorou D, Stefanaki I, Kypreou K, Theology V, Stratigos AJ. A Retrospective Study of Diameter and Breslow Thickness in Invasive Melanomas. Dermatology 2024; 240:462-467. [PMID: 38290473 DOI: 10.1159/000536151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION A diameter larger than 6 mm is included in the criteria used in public health messages to detect a cutaneous melanoma. We aimed to investigate the independent association of Breslow thickness with the melanoma diameter. METHODS A retrospective study was performed in patients with invasive melanomas of the nodular melanoma (NM) or superficial spreading melanoma (SSM) subtype. The quartiles of the diameter (lower, median, upper) were studied in non-parametric quantile regression model. RESULTS In total, 537 cases of invasive melanomas were included and 60% had Breslow thickness ≤1.0 mm. There were 429 SSM (79.9%) and 108 NM (20.1%). Although NMs were significantly thicker (median Breslow thickness: 2.7 mm vs. 0.7 mm, respectively, p < 0.0001), they were not associated with larger diameter compared to SSMs (p = 0.71). After adjustment for age and sex, melanoma location and subtype, having Breslow thickness ≤1.0 mm was not significantly associated with the lower quartile, median and upper quartile of the diameter (p values: 0.063, 0.083, and 0.791, respectively). CONCLUSION In our study including melanomas of the NM or SSM subtype, Breslow thickness was not associated with the diameter, adding evidence to support the limitations of using diameter larger than 6 mm for the detection of invasive melanomas and indicating the potential of smaller melanomas to be thicker tumors.
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Affiliation(s)
- Clio Dessinioti
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
| | - Mihaella Plaka
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
| | - Angelliki Befon
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
- State Department of Dermatology, A.Sygros Hospital, Athens, Greece
| | - Dorothea Polidorou
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
- State Department of Dermatology, A.Sygros Hospital, Athens, Greece
| | - Irene Stefanaki
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
| | - Katerina Kypreou
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
| | - Varvara Theology
- Department of Histopathology, A.Sygros Hospital, University of Athens, Athens, Greece
| | - Alexander J Stratigos
- Skin Cancer and Melanoma Unit, 1st Department of Dermatology, A.Sygros Hospital, University of Athens, Athens, Greece
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Salijuma E, Maskalane J, Lallas K, Papageorgiou C, Gkentsidi T, Manoli SM, Eftychidou P, Sakellaropoulou S, Nikolaidou C, Vakirlis E, Sotiriou E, Apalla Z, Lallas A. Poor correlation between diameter and Breslow thickness of melanoma. J Eur Acad Dermatol Venereol 2024; 38:e56-e58. [PMID: 37595962 DOI: 10.1111/jdv.19431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- E Salijuma
- Dermatology Clinic: Prof. J. Kisis & Asst. Prof. Rone-Kupfere, Riga, Latvia
| | - J Maskalane
- Dr. Maurins Laser Medical Clinic, Riga, Latvia
| | - K Lallas
- Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - C Papageorgiou
- Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - T Gkentsidi
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - S M Manoli
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - P Eftychidou
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - S Sakellaropoulou
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - C Nikolaidou
- Department of Histopathology, Ippokrateio General Hospital, Thessaloniki, Greece
| | - E Vakirlis
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - E Sotiriou
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Z Apalla
- Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - A Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
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Coetzer-Botha M, Jimenez Balcells C, Hay J, Keir J, Rosendahl N, Wilson T, Clark S, Baade A, Becker C, Bookallil L, Clifopoulos C, Dicker T, Denby MP, Duthie D, Elliott C, Fishburn P, Foley M, Franck M, Giam I, Gordillo P, Lilleyman A, Macauley R, Maher J, McPhee E, Reid M, Shirlaw B, Siggs G, Spark R, Stretch J, van Den Heever K, van Rensburg T, Watson C, Kittler H, Rosendahl C. Practitioner characteristics, diagnostic accuracy metrics and discovering-individual with respect to 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database. Australas J Dermatol 2023; 64:378-388. [PMID: 37092604 DOI: 10.1111/ajd.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Knowledge of accuracy for melanoma diagnosis and melanoma discovering-individual in primary care is limited. We describe general practitioner (GP) characteristics and analyse defined diagnostic accuracy metrics for GPs in the current study comparing this with a previous study for GPs common to both, and we analyse the individual first discovering each melanoma as a lesion of concern. METHODS The characteristics and diagnostic accuracy of 27 Australasian GPs documenting 637 melanomas on the Skin Cancer Audit Research Database (SCARD) in 2013 were described and analysed. The number needed to treat (NNT) and percentage of melanomas that were in situ (percentage in situ) were analysed as surrogates for specificity and sensitivity, respectively. The discovering-individual was analysed according to patient age and sex and lesion Breslow thickness. RESULTS The average NNT and percentage in situ were 5.73% and 65.07%, respectively. For 21 GPs in both a 2008-2010 study and the current study, the NNT was 10.78 and 5.56, respectively (p = 0.0037). A consistent trend of decreasing NNT and increasing percentage in situ through increasingly subspecialised GP categories did not reach statistical significance. NNT trended high at ages and sites for which melanoma was rare. While the patient or family member was more likely to discover thick melanomas and melanomas in patients under 40 years, GPs discovered 73.9% of the melanomas as lesions of concern. CONCLUSIONS GPs were the discovering-individuals for the majority of melanomas in the current study and their accuracy metrics compared favourably with published figures for dermatologists and GPs.
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Affiliation(s)
- Martelle Coetzer-Botha
- General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia
| | - Clara Jimenez Balcells
- 4D Skin Cancer Clinic, Belmont North, New South Wales, Australia
- Universitat de Autonoma de Barcelona (UAB), Catalunya, Spain
| | - Jeremy Hay
- Upper Hutt Skin Clinic, Upper Hutt, Wellington, New Zealand
| | - Jeff Keir
- General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia
| | - Nikita Rosendahl
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | | | - Simon Clark
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Tehran University of Medical Sciences, Tehran, Iran
| | - Astrid Baade
- Gladstone GP Superclinic, Gladstone, Queensland, Australia
| | - Cath Becker
- Wairarapa Skin Clinic, Masterton, New Zealand
- Wairarapa Hospital, Lansdowne, Masterton, New Zealand
| | - Luke Bookallil
- The University of New England, Armidale, New South Wales, Australia
| | - Chris Clifopoulos
- General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia
| | - Tony Dicker
- General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia
| | | | - Douglas Duthie
- Darwin Skin Cancer Clinic, Parap, Northern Territory, Australia
| | - Charles Elliott
- Solarderm Skin Cancer Practice, Caboolture, Queensland, Australia
| | - Paul Fishburn
- General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia
| | - Mark Foley
- The Skin Clinic, Marlborough, Blenheim, New Zealand
| | - Mark Franck
- MoleSafe Skin Cancer Clinic, Windsor, Victoria, Australia
| | - Irene Giam
- Skin2 Clinic, Deakin, Australian Capital Territory, Australia
| | | | | | - Roger Macauley
- Bateau Bay Medical Centre, Bateau Bay, New South Wales, Australia
| | - James Maher
- Skin Cancer Ballarat, Alfredton, Victoria, Australia
| | - Ewen McPhee
- Emerald Medical Group, Emerald, Queensland, Australia
| | - Michael Reid
- Nelson Bay Skin Cancer Clinic, Nelson Bay, New South Wales, Australia
| | - Bob Shirlaw
- Lakeside Medical, Springfield Lakes, Queensland, Australia
| | - Graeme Siggs
- Regency Medical Clinic, Sefton Park, South Australia, Australia
| | - Robert Spark
- Toukley Family Practice, Toukley, New South Wales, Australia
| | | | | | | | - Chris Watson
- Brisbane City Doctors, Brisbane, Queensland, Australia
| | - Harald Kittler
- Vienna Dermatologic Imaging Research Group, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Cliff Rosendahl
- General Practice Clinical Unit, Medical School, The University of Queensland, St Lucia, Queensland, Australia
- Tehran University of Medical Sciences, Tehran, Iran
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Spanos S, Singh N, Laginha BI, Arnolda G, Wilkinson D, Smith AL, Cust AE, Braithwaite J, Rapport F. Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol 2023; 64:177-193. [PMID: 36960976 PMCID: PMC10952799 DOI: 10.1111/ajd.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Bela I. Laginha
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - David Wilkinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- National Skin Cancer CentresSouth BrisbaneQueenslandAustralia
| | - Andrea L. Smith
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Anne E. Cust
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
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Hay J, Keir J, Jimenez Balcells C, Rosendahl N, Coetzer‐Botha M, Wilson T, Clark S, Baade A, Becker C, Bookallil L, Clifopoulos C, Dicker T, Denby MP, Duthie D, Elliott C, Fishburn P, Foley M, Franck M, Giam I, Gordillo P, Lilleyman A, Macauley R, Maher J, McPhee E, Reid M, Shirlaw B, Siggs G, Spark R, Stretch J, van Den Heever K, van Rensburg T, Watson C, Kittler H, Rosendahl C. Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database. Australas J Dermatol 2022; 63:204-212. [PMID: 35437755 PMCID: PMC9320831 DOI: 10.1111/ajd.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/24/2022] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Jeremy Hay
- Upper Hutt Skin ClinicUpper Hutt, WellingtonNew Zealand
| | - Jeff Keir
- General Practice Clinical UnitMedical SchoolThe University of QueenslandAustralia
| | | | - Nikita Rosendahl
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | | | | | - Simon Clark
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
- Tehran University of Medical SciencesTehranIran
| | - Astrid Baade
- Gladstone GP SuperclinicGladstoneQueenslandAustralia
| | - Cath Becker
- Wairarapa Skin ClinicMastertonNew Zealand
- Wairarapa HospitalLansdowne, MastertonNew Zealand
| | - Luke Bookallil
- The University of New EnglandArmidaleNew South WalesAustralia
| | - Chris Clifopoulos
- General Practice Clinical UnitMedical SchoolThe University of QueenslandAustralia
| | - Tony Dicker
- General Practice Clinical UnitMedical SchoolThe University of QueenslandAustralia
| | | | - Douglas Duthie
- Darwin Skin Cancer ClinicParapNorthwest TerritoriesAustralia
| | | | - Paul Fishburn
- General Practice Clinical UnitMedical SchoolThe University of QueenslandAustralia
| | - Mark Foley
- The Skin ClinicMarlborough – BlenheimNew Zealand
| | - Mark Franck
- MoleSafe Skin Cancer ClinicWindsorVictoriaAustralia
| | - Irene Giam
- Skin ClinicDeakinAustralian Capital TerritoryAustralia
| | | | | | - Roger Macauley
- Bateau Bay Medical CentreBateau BayNew South WalesAustralia
| | - James Maher
- Skin Cancer BallaratAlfredtonVictoriaAustralia
| | - Ewen McPhee
- Emerald Medical GroupEmeraldQueenslandAustralia
| | - Michael Reid
- Nelson Bay Skin Cancer ClinicNelson BayNew South WalesAustralia
| | - Bob Shirlaw
- Lakeside MedicalSpringfield LakesQueenslandAustralia
| | - Graeme Siggs
- Regency Medical ClinicSefton ParkSouth AustraliaAustralia
| | - Robert Spark
- Toukley Family PracticeToukleyNew South WalesAustralia
| | | | | | | | - Chris Watson
- Brisbane City DoctorsBrisbaneQueenslandAustralia
| | - Harald Kittler
- Vienna Dermatologic Imaging Research Group, Department of DermatologyMedical University of ViennaViennaAustria
| | - Cliff Rosendahl
- General Practice Clinical UnitMedical SchoolThe University of QueenslandAustralia
- Tehran University of Medical SciencesTehranIran
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