title: Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia.
abstract: BACKGROUND
  Knowledge of variation in diagnosis and surgery in high-risk primary melanoma patients is limited. We assessed frequency and determinants of diagnostic procedures, wide local excision (WLE) and sentinel lymph node biopsy (SLNB).
  
  
  METHODS
  People in Queensland newly diagnosed with melanoma, clinical stage 1b or 2, were recruited prospectively. Patient information was collected from questionnaires and pathology records. Differences in surgical procedures in relation to host and tumor characteristics were assessed.
  
  
  RESULTS
  In 787 participants, primary melanoma was diagnosed by surgical excision (74%), shave (14%), punch (12%) or incisional (1%) biopsy. General practitioners (GPs) diagnosed 80%. Diagnostic procedure differed by remoteness of residence, health sector, treating doctor's specialty and melanoma site and thickness. 766 patients had WLE, 86% by surgeons. Of 134 residual melanomas, 13 (10%) were ≤ 1 mm at diagnosis but > 1 mm at WLE, mostly after shave biopsy. SLNB was performed in 261 (33%) patients. SLNB was more common in those under 50, in remoter locations or treated by GP initially, and less common with head and neck melanoma.
  
  
  CONCLUSIONS
  Diagnostic and surgical procedures for primary melanoma vary substantially and partial biopsy can influence initial tumor microstaging. Patient, tumor and doctor characteristics influence SLNB practice.
authors: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.
authors: B Mark
authors: BM
authors: Smithers
authors: Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute,, Brisbane, Australia.
authors: Maria Celia B
authors: MC
authors: Hughes
authors: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors: Vanessa L
authors: VL
authors: Beesley
authors: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.
authors: Andrew P
authors: AP
authors: Barbour
authors: Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute,, Brisbane, Australia.
authors: Maryrose K
authors: MK
authors: Malt
authors: Sullivan Nicolaides Pathology, Indooroopilly, Australia.
authors: David
authors: D
authors: Weedon
authors: The Townsville Hospital, Townsville, Australia.|Mater Medical Centre, Pimlico, Australia.
authors: Mark J
authors: MJ
authors: Zonta
authors: IQ Pathology, South Brisbane, Australia.
authors: Dominic J
authors: DJ
authors: Wood
authors: IQ Pathology, South Brisbane, Australia.
authors: Joseph A
authors: JA
authors: Triscott
authors: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.|Phoenix Plastic Surgery Institute, Greenslopes, Australia.
authors: Gerard J
authors: GJ
authors: Bayley
authors: Kawana Private Hospital, Sunshine Coast, Australia.
authors: Lee J
authors: LJ
authors: Brown
authors: Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.|Mater Health Services, South Brisbane, Australia.
authors: Christopher P
authors: CP
authors: Allan
authors: Nambour General Hospital, Nambour, Australia.
authors: Justin
authors: J
authors: D'Arcy
authors: Zenith Specialist Pathology, South Brisbane, Australia.
authors: Richard
authors: R
authors: Williamson
authors: Experimental Dermatology Group, The University of Queensland Centre for Clinical Research & The University of Queensland Diamantina Institute, Brisbane, Australia.
authors: Kiarash
authors: K
authors: Khosrotehrani
authors: Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute,, Brisbane, Australia.|CRUK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, England.
authors: Adèle C
authors: AC
authors: Green
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D000096142:Cutaneous Malignant Melanoma
keywords: excision; melanoma; sentinel node