Non-compliance with the re-excision guidelines for cutaneous melanoma in The Netherlands does not influence survival.
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.
Haniff
J
J
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
de Vries
E
E
Claassen
A T P M
AT
Looman
C W N
CW
van Berlo
Ch
Ch
Coebergh
J W W
JW
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