title: Non-compliance with the re-excision guidelines for cutaneous melanoma in The Netherlands does not influence survival.
abstract: OBJECTIVE
  To evaluate causes and consequences of not adhering to the clinical practice guideline for cutaneous malignant melanoma.
  
  
  METHODS
  We conducted a retrospective cohort study of the clinical records of 454 subjects whose pathological reports were obtained from a population-based cancer registry to assess determinants and effects of non-compliance of physicians with the excision policy and the related clinical practice guideline for patients with primary localized cutaneous malignant melanoma (CMM). A comparative analysis was performed of patients who did and did not undergo re-excision (compliance versus non-compliance with the guideline). Subjects diagnosed in 1988, 1993 and 1997, just 1 year after publication of the (adapted) guideline, were followed until death due to any cause or until July 1st 2003.
  
  
  RESULTS
  Old age was the most important determinant of non-compliance. After adjusting for age at diagnosis, gender, subsite and Breslow thickness there was no significant difference in overall survival between the compliance group and the non-compliance group.
  
  
  CONCLUSIONS
  Non-compliance to the guideline is more common in older patients and in patients with melanoma in the head and neck region. After adjusting for confounders, a significant effect of complying with the guidelines on overall survival could not be observed.
authors.affiliation: Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Haniff
authors.forename: E
authors.initials: E
authors.lastname: de Vries
authors.forename: A T P M
authors.initials: AT
authors.lastname: Claassen
authors.forename: C W N
authors.initials: CW
authors.lastname: Looman
authors.forename: Ch
authors.initials: Ch
authors.lastname: van Berlo
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000367:Age Factors; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012086:Reoperation / Q000592:standards; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends