Adele C Green1, Nirmala Pandeya2, Sarah Morton3, John Simonidis4, David C Whiteman5. 1. Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia; CRUK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, United Kingdom. Electronic address: Adele.Green@qimrberghofer.edu.au. 2. Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia. Electronic address: Nirmala.Pandeya@qimrberghofer.edu.au. 3. Royal Brisbane and Women's Hospital, Brisbane, Herston, Queensland, 4006, Australia. Electronic address: skmorton94@gmail.com. 4. The Melanoma Centre, Spring Hill, Brisbane 4000, Australia. Electronic address: dageonic@tpg.com.au. 5. Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia. Electronic address: David.Whiteman@qimrbeghofer.edu.au.
Abstract
BACKGROUND: Primary care skin cancer clinics facilitate early treatment of melanoma in Australia. We investigated the clinical and histopathological features of melanomas diagnosed and treated in an established clinic in Brisbane. METHODS: Retrospective audit of medical records of patients diagnosed with in situ or invasive primary cutaneous melanoma in a primary care clinic specializing in skin cancer, 2000-2017. Demographic and clinical data were standardly extracted by a medically-trained investigator. We used descriptive analyses to assess characteristics of patients and melanomas, and examine surgical management according to tumour thickness. RESULTS: Of 380 patients (median age 57 years; 57 % male) newly diagnosed with 497 histologically-confirmed primary cutaneous melanomas, 369 were in situ and 128 invasive. Of the 369 in situ melanomas, 143 (39 %) were on the trunk and 87 (24 %) on the head and neck; 247 (67 %) were diagnosed by shave biopsy; and 141 (38 %) referred for wide local excision (WLE). Of the 128 invasive melanomas, only 21 (16 %) had thickness ≥ 0.8 mm and these occurred more often on head and neck than thin invasive melanomas (p = 0.02). The majority of invasive melanomas were diagnosed by excision biopsy, and WLE was carried out in a median of 3 days (melanomas ≥ 0.8 mm) and 2 days (<0.8 mm). The doctor detected the majority of in situ (83 %) and thin invasive (73 %) melanomas during surveillance, compared with 48 % of thicker invasive melanomas ≥ 0.8 mm (p < 0.001). CONCLUSION: In Australia, specialised primary care practice plays a major role in detection and treatment of early primary melanoma.
BACKGROUND: Primary care skin cancer clinics facilitate early treatment of melanoma in Australia. We investigated the clinical and histopathological features of melanomas diagnosed and treated in an established clinic in Brisbane. METHODS: Retrospective audit of medical records of patients diagnosed with in situ or invasive primary cutaneous melanoma in a primary care clinic specializing in skin cancer, 2000-2017. Demographic and clinical data were standardly extracted by a medically-trained investigator. We used descriptive analyses to assess characteristics of patients and melanomas, and examine surgical management according to tumour thickness. RESULTS: Of 380 patients (median age 57 years; 57 % male) newly diagnosed with 497 histologically-confirmed primary cutaneous melanomas, 369 were in situ and 128 invasive. Of the 369 in situ melanomas, 143 (39 %) were on the trunk and 87 (24 %) on the head and neck; 247 (67 %) were diagnosed by shave biopsy; and 141 (38 %) referred for wide local excision (WLE). Of the 128 invasive melanomas, only 21 (16 %) had thickness ≥ 0.8 mm and these occurred more often on head and neck than thin invasive melanomas (p = 0.02). The majority of invasive melanomas were diagnosed by excision biopsy, and WLE was carried out in a median of 3 days (melanomas ≥ 0.8 mm) and 2 days (<0.8 mm). The doctor detected the majority of in situ (83 %) and thin invasive (73 %) melanomas during surveillance, compared with 48 % of thicker invasive melanomas ≥ 0.8 mm (p < 0.001). CONCLUSION: In Australia, specialised primary care practice plays a major role in detection and treatment of early primary melanoma.
Authors: Jeremy Hay; Jeff Keir; Clara Jimenez Balcells; Nikita Rosendahl; Martelle Coetzer-Botha; Tobias Wilson; Simon Clark; Astrid Baade; Cath Becker; Luke Bookallil; Chris Clifopoulos; Tony Dicker; Martin Paul Denby; Douglas Duthie; Charles Elliott; Paul Fishburn; Mark Foley; Mark Franck; Irene Giam; Patricio Gordillo; Alister Lilleyman; Roger Macauley; James Maher; Ewen McPhee; Michael Reid; Bob Shirlaw; Graeme Siggs; Robert Spark; John Stretch; Keith van Den Heever; Thinus van Rensburg; Chris Watson; Harald Kittler; Cliff Rosendahl Journal: Australas J Dermatol Date: 2022-04-19 Impact factor: 2.481