The management of primary cutaneous melanoma in Victoria in 1996 and 2000.
OBJECTIVE
To describe tumour characteristics and clinical management of melanomas newly diagnosed in 1996 and in 2000--before and after publication of the clinical practice "Guidelines for the management of cutaneous melanoma" by the Australian Cancer Network (1997), and their endorsement by the National Health and Medical Research Council (NHMRC) and republication (1999).


METHODS
Survey of clinicians involved in the management of patients with melanoma sampled from the Victorian Cancer Registry. The Registry is notified of all cases of cancer diagnosed by pathology laboratories and hospitals in both the public and private health sectors in the state of Victoria.


METHODS
People with a cutaneous melanoma newly diagnosed in 1996 and 2000. All invasive melanomas > 1.50 mm in thickness were included, and for each year random samples were selected of 100 each of invasive melanomas 0.76-1.50 mm in thickness, invasive melanomas < or = 0.75 mm, and in-situ melanomas, plus 50 melanomas of unknown thickness.


METHODS
Biopsy method, adequacy of pathology reporting, adequacy of definitive excision (compared with margins recommended by the Guidelines), and follow-up procedures.


RESULTS
The use of partial biopsies increased between 1996 and 2000. Recommended margins of definitive excision were used in only 33.6% of cases. Margins were smaller than recommended for 36% of in-situ melanomas, risking recurrence of primary melanoma. Documented follow-up examinations for subsequent primary skin malignancy were uncommon (6%).


CONCLUSIONS
Many aspects of the management of primary cutaneous melanoma appear not to meet the recommendations of the published Guidelines. Further studies to explore the reasons for failure to meet the Guideline recommendations are needed.
Kelly
John W
JW
Victorian Melanoma Service and Dermatology Unit, Alfred Hospital, Melbourne, Victoria, Australia. kellyderm@bigpond.com
Henderson
Michael A
MA
Thursfield
Vicky J
VJ
Slavin
John
J
Ainslie
Jill
J
Giles
Graham G
GG
D000368:Aged; D001315:Australia / Q000453:epidemiology; D001706:Biopsy / Q000379:methods / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012042:Registries; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires