title: Use of an early-detection strategy to improve disease control in melanoma patients.
abstract: In order to assess whether early detection might lead to improvement in disease control for patients with melanoma, a rapid access pigmented lesion clinic (PLC) was set up at Mount Vernon Hospital, UK in 1993. Previously we have shown that thinner melanomas were detected via the PLC compared with those presenting prior to its establishment and with those referred via existing routes of referral. The aim of this study was to investigate whether both rates of disease recurrence and disease-free interval were improved via a rapid access PLC. A retrospective case notes audit was performed on three patient groups: those diagnosed with melanoma 1991-1992, those diagnosed via the PLC (1993-1996) and those diagnosed with melanoma through existing routes of referral after establishment of the PLC (1993-1996). There was a significantly improved disease-free interval for patients with regional recurrences diagnosed via the pigmented lesion clinic (PLC) when compared with pre-PLC, non-PLC groups (chi2=13.8487, p=0.0002; chi2=17.0164, p<0.0001, respectively), and when compared with all melanoma patients diagnosed after the establishment of the PLC, irrespective of route of referral (chi2=5.2773, p=0.0216). Local recurrences developed later in patients in the PLC group compared with the pre-PLC group (chi2=6.4883, p=0.0109), and the non-PLC group (chi2=18.49, p<0.0001). In addition there was a reduction in the proportion of regional and local recurrences in the PLC group when compared with the pre-PLC group (chi2=13.92, P<0.001; chi2=2.85, P=0.09 respectively) and non-PLC group (chi2=17.15, P<0.001; chi2=7.73, P=0.005, respectively). These results support the use of rapid access PLCs as a means of improving disease control for melanoma patients.
authors.affiliation: The RAFT Institute of Plastic Surgery, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK. marcpacifico@dial.pipex.com
authors.forename: M D
authors.initials: MD
authors.lastname: Pacifico
authors.forename: R
authors.initials: R
authors.lastname: Grover
authors.forename: R
authors.initials: R
authors.lastname: Sanders
mesh_terms: D000554:Ambulatory Care Facilities; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000401:mortality; D016896:Treatment Outcome