Kirtana Vedire1, Andrew L Joselow2, Craig M Markham1, Gregory J Raugi3. 1. VA Puget Sound Health Care System, Seattle Division, USA. 2. VA Puget Sound Health Care System, Seattle Division, USA Tulane University School of Medicine, New Orleans, USA. 3. VA Puget Sound Health Care System, Seattle Division, USA University of Washington, Department of Medicine (Dermatology), Seattle, USA gregory.raugi@va.gov.
Abstract
METHODS: We conducted a retrospective chart review and identified 186 Veterans in the VA Corporate Data Warehouse as having malignant melanomas or severely dysplastic nevi during the four-year period of observation from 1 July 2009 to 30 June 2013 and met inclusion and exclusion criteria for analysis. RESULTS: Three hundred and sixty-six surgical procedures were performed for diagnosis and treatment of these conditions including biopsy and wide-local excision, of which 189 carefully selected cases were performed by primary care clinicians with 2.0% biopsy complication rate and a 7.7% wide-local excision complication rate. Cases not performed by primary care providers were referred to specialists (e.g. dermatologists, general surgeons or specialty surgeons) who had a 2.5% complication rate in biopsies and wide-local excision complication rate of 13.5% in severely dysplastic nevi and pTis and pT1a lesions and a 10.7% complication rate for lesions pT1b and greater. DISCUSSION: These results show that a significant fraction of surgical procedures for diagnosis and treatment of malignant melanoma and severely dysplastic nevi can be safely performed in rural clinics by trained primary care providers.
METHODS: We conducted a retrospective chart review and identified 186 Veterans in the VA Corporate Data Warehouse as having malignant melanomas or severely dysplastic nevi during the four-year period of observation from 1 July 2009 to 30 June 2013 and met inclusion and exclusion criteria for analysis. RESULTS: Three hundred and sixty-six surgical procedures were performed for diagnosis and treatment of these conditions including biopsy and wide-local excision, of which 189 carefully selected cases were performed by primary care clinicians with 2.0% biopsy complication rate and a 7.7% wide-local excision complication rate. Cases not performed by primary care providers were referred to specialists (e.g. dermatologists, general surgeons or specialty surgeons) who had a 2.5% complication rate in biopsies and wide-local excision complication rate of 13.5% in severely dysplastic nevi and pTis and pT1a lesions and a 10.7% complication rate for lesions pT1b and greater. DISCUSSION: These results show that a significant fraction of surgical procedures for diagnosis and treatment of malignant melanoma and severely dysplastic nevi can be safely performed in rural clinics by trained primary care providers.
Authors: Roland Koch; Andreas Polanc; Hannah Haumann; Gudula Kirtschig; Peter Martus; Christian Thies; Leonie Sundmacher; Carmen Gaa; Leonard Witkamp; Stefanie Joos Journal: Trials Date: 2018-10-24 Impact factor: 2.279