title: Adverse outcomes associated with noncompliance with melanoma treatment guidelines.
abstract: BACKGROUND
  Clinical practice guidelines have been developed to improve melanoma patient care. However, it is unclear whether failure to comply with these standards (either excessive or inadequate treatment) increases morbidity or relapse rates. Therefore, we undertook this study to evaluate the effect of variance from National Comprehensive Cancer Network (NCCN) recommendations on postoperative complication rates and disease recurrence.
  
  
  METHODS
  We retrospectively reviewed our institutional cancer registry data on 327 clinically node-negative melanoma patients and assessed compliance with NCCN guidelines, complication rates, and outcome. Data were confirmed by chart, pathology report, and operative note review. Statistical analysis was performed by using the SAS statistical software package.
  
  
  RESULTS
  Postoperative complications were documented in 17% of patients and were 3.4-fold higher for patients treated in a margin-noncompliant fashion and 2.4-fold higher for patients treated in a lymph-node-noncompliant manner (P < 0.001 for both). After mean follow-up of 51 months, disease recurred in 58 patients (18%) at a mean of 33 months (range 4-93 months). Locoregional disease alone as the first site of relapse was seen in 24% of margin-noncompliant versus 6% of margin-compliant cases and in 33% of lymph-node-noncompliant versus 6% of lymph-node-compliant cases (P < 0.0001).
  
  
  CONCLUSIONS
  While there are valid reasons for variance from treatment algorithms, these data suggest that compliance with NCCN guidelines improves outcome and decreases morbidity in clinically node-negative melanoma patients.
authors.affiliation: Department of Surgery, Rush North Shore Medical Center, 9669 North Kenton, Suite 204, Skokie, IL, 60076, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Erickson Foster
authors.forename: Josè M
authors.initials: JM
authors.lastname: Velasco
authors.forename: Tina J
authors.initials: TJ
authors.lastname: Hieken
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*