title: Standardization and quality control of surgical treatment of cutaneous melanoma: looking for consensus of the Italian melanoma intergroup.
abstract: BACKGROUND
  Quality of surgical care can be an important contributor to differences in survival among patients, and this suggests considerable potential for quality improvement in surgery of melanoma. Although clinical practice guidelines (CPG) for melanoma have been produced by various organizations, none address in detail some aspects of care related to surgery, and this brings about a quite heterogeneous surgical approach. Thus, Quality Assurance (QA) programs in melanoma surgery are essential.
  
  
  METHODS
  Using the RAND/UCLA Appropriateness Method, an Italian panel of expert surgeons and pathologists belonging to the Italian Melanoma Intergroup (IMI) were invited to vote on statements regarding surgical treatment of melanoma and potential quality indicators for QA. All statements/indicators were scored for appropriateness and judged as valid in cases of 90% agreement.
  
  
  RESULTS
  Consensus was obtained on 15 statements regarding indications for and extent of surgery (wide excision, sentinel node biopsy and lymphadenectomy) and on 7 QA indicators suitable to measure surgical performance for internal audit.
  
  
  CONCLUSIONS
  The obtained consensus represents the basis to start a standardized QA program in Italy. The benchmark values of each indicator will be completed and updated according to the forthcoming results of the Clinical National Melanoma Registry (CNMR). Promoting a QA program at each IMI institution should increase the standard of care for melanoma patients in Italy.
authors.affiliation: Melanoma and Sarcoma Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy. Electronic address: antonio.sommariva@ioveneto.it.
authors.forename: A
authors.initials: A
authors.lastname: Sommariva
authors.affiliation: Pathology and Cytopathology Unit, Casa di Cura San Pio X, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Clemente
authors.affiliation: Melanoma and Sarcoma Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Rossi
mesh_terms: D062109:Dermatologic Surgical Procedures / Q000592:standards*; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision / Q000592:standards*; D008545:Melanoma / Q000601:surgery*; D011786:Quality Control; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D021701:Sentinel Lymph Node Biopsy / Q000592:standards*; D012878:Skin Neoplasms / Q000601:surgery*
keywords: Health care; Melanoma; Quality control; Quality indicators; Surgery