Variations in management of stage I to stage III cutaneous melanoma: a population-based study of clinical practices in France.
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.
Grange
Florent
F
Service de Dermatologie, Hôpital Robert Debré, Avenue du Général Koenig, 51092 Reims CEDEX, France. fgrange@chu-reims.fr
Vitry
Fabien
F
Granel-Brocard
Florence
F
Lipsker
Dan
D
Aubin
Francois
F
Hédelin
Guy
G
Dalac
Sophie
S
Truchetet
François
F
Michel
Catherine
C
Batard
Marie-Laure
ML
Baury
Béatrice
B
Halna
Jean-Michel
JM
Schmutz
Jean Luc
JL
Delvincourt
Christian
C
Reuter
Georges
G
Dalle
Stéphane
S
Bernard
Phillipe
P
Danzon
Arlette
A
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
D000970:Antineoplastic Agents; D007372:Interferons