title: Variations in management of stage I to stage III cutaneous melanoma: a population-based study of clinical practices in France.
abstract: OBJECTIVE
  To describe current management of cutaneous melanoma (CM) and identify factors accounting for disparities.
  
  
  METHODS
  Retrospective population-based study using survey of cancer registries and pathology laboratories, and questionnaires to physicians.
  
  
  METHODS
  Five regions covering 19.2% of the French territory and including 8.2 million inhabitants.
  
  
  METHODS
  Incident cases of patients with stage I to stage II (hereinafter, stage I-II) tumors staged according to the American Joint Committee on Cancer Staging guidelines and nodal stage III CM in 2004.
  
  
  METHODS
  Modalities of diagnosis and excision, surgical margins, sentinel lymph node biopsy, adjuvant therapies and surveillance procedures, and their variations according to age, sex, residence, location of primary CM, Breslow thickness, type of physicians, modalities of decisions, and health care patterns.
  
  
  RESULTS
  Clinical stage I-II CMs (n = 710 cases) slightly predominated in females (53%), with a lower mean Breslow thickness (1.4 mm) than in males (1.9 mm). Initial excisions were most often performed by private dermatologists and wide excisions by surgeons. Narrow margins (8%) were associated with advanced age, higher Breslow thickness, and head location. Sentinel lymph node biopsy was performed in 34% of CMs thicker than 1.0 mm, depending on geographical regions, distance from reference centers, and health care patterns. Adjuvant therapies (mainly low-dose interferon) were proposed in 53% of thick CMs (>1.5 mm), depending on the patient's age and geographical region. In contrast with French recommendations, surveillance procedures frequently included systematic medical imaging. Stage III nodal CMs (n = 89 cases) predominated in males (62%). After lymphadenectomy, adjuvant therapies (including high-dose interferon in 32% of cases and chemotherapies in 24% of cases) were proposed in 68% of cases, depending on the patient's age and geographical region. A complete 1-year high-dose interferon regimen was administered in less than 10% of cases.
  
  
  CONCLUSIONS
  Large disparities still exist in the management of CM in France, depending to a greater extent on medical and geographical environment than on the characteristics of either patients or tumors.
authors.affiliation: Service de Dermatologie, Hôpital Robert Debré, Avenue du Général Koenig, 51092 Reims CEDEX, France. fgrange@chu-reims.fr
authors.forename: Florent
authors.initials: F
authors.lastname: Grange
authors.forename: Fabien
authors.initials: F
authors.lastname: Vitry
authors.forename: Florence
authors.initials: F
authors.lastname: Granel-Brocard
authors.forename: Dan
authors.initials: D
authors.lastname: Lipsker
authors.forename: Francois
authors.initials: F
authors.lastname: Aubin
authors.forename: Guy
authors.initials: G
authors.lastname: Hédelin
authors.forename: Sophie
authors.initials: S
authors.lastname: Dalac
authors.forename: François
authors.initials: F
authors.lastname: Truchetet
authors.forename: Catherine
authors.initials: C
authors.lastname: Michel
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Batard
authors.forename: Béatrice
authors.initials: B
authors.lastname: Baury
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Halna
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Schmutz
authors.forename: Christian
authors.initials: C
authors.lastname: Delvincourt
authors.forename: Georges
authors.initials: G
authors.lastname: Reuter
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dalle
authors.forename: Phillipe
authors.initials: P
authors.lastname: Bernard
authors.forename: Arlette
authors.initials: A
authors.lastname: Danzon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003880:Dermatology / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D005602:France; D006801:Humans; D007372:Interferons / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D007372:Interferons