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Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia
Author(s) -
Smithers B. Mark,
Hughes Maria Celia B.,
Beesley Vanessa L.,
Barbour Andrew P.,
Malt Maryrose K.,
Weedon David,
Zonta Mark J.,
Wood Dominic J.,
Triscott Joseph A.,
Bayley Gerard J.,
Brown Lee J.,
Allan Christopher P.,
D'Arcy Justin,
Williamson Richard,
Khosrotehrani Kiarash,
Green Adèle C.
Publication year - 2015
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24013
Subject(s) - medicine , melanoma , biopsy , wide local excision , sentinel lymph node , surgery , stage (stratigraphy) , dermatology , cancer , general surgery , radiology , breast cancer , cancer research , paleontology , biology
Background Knowledge of variation in diagnosis and surgery in high‐risk primary melanoma patients is limited. We assessed frequency and determinants of diagnostic procedures, wide local excision (WLE) and sentinel lymph node biopsy (SLNB). Methods People in Queensland newly diagnosed with melanoma, clinical stage 1b or 2, were recruited prospectively. Patient information was collected from questionnaires and pathology records. Differences in surgical procedures in relation to host and tumor characteristics were assessed. Results In 787 participants, primary melanoma was diagnosed by surgical excision (74%), shave (14%), punch (12%) or incisional (1%) biopsy. General practitioners (GPs) diagnosed 80%. Diagnostic procedure differed by remoteness of residence, health sector, treating doctor's specialty and melanoma site and thickness. 766 patients had WLE, 86% by surgeons. Of 134 residual melanomas, 13 (10%) were ≤ 1 mm at diagnosis but > 1 mm at WLE, mostly after shave biopsy. SLNB was performed in 261 (33%) patients. SLNB was more common in those under 50, in remoter locations or treated by GP initially, and less common with head and neck melanoma. Conclusion Diagnostic and surgical procedures for primary melanoma vary substantially and partial biopsy can influence initial tumor microstaging. Patient, tumor and doctor characteristics influence SLNB practice. J. Surg. Oncol. 2015; 112:359–365 . © 2015 Wiley Periodicals, Inc.