title: A population-based assessment of melanoma: Does treatment in a regional cancer center make a difference?
abstract: BACKGROUND
  Regionalization of care to specialized centers has improved outcomes for several cancer types. We sought to determine if treatment in a regional cancer center (RCC) impacts guideline adherence and outcomes for patients with melanoma.
  
  
  METHODS
  In Alberta, Canada, 561 patients with stage I-IIIC primary melanoma were diagnosed between January 2009 and December 2010. The electronic health record was used to capture demographic and pathologic data. Provincial guidelines for sentinel lymph node biopsy (SLNB) and wide local excision (WLE) are based on recommendations of several pre-existing guidelines including the National Comprehensive Cancer Network.
  
  
  RESULTS
  148 of 561 patients were identified as having been treated at a RCC. Median follow-up was 45 months. Patients treated at the RCC presented with higher stage melanomas. The RCC was more likely to follow guideline recommendations for performing SLNB (81.3% vs. 55.4%, P < 0.0001) but not for the extent of WLE (76.6% vs. 84.1%, P = 0.054). Overall survival was impacted by tumor thickness (HR 1.14, P < 0.0001), ulceration (HR 5.58, P < 0.0001), and mitoses (HR 0.59, P = 0.05).
  
  
  CONCLUSIONS
  The RCC more closely followed guidelines for SLNB but not for WLE. Despite patients treated at the RCC presenting with a more advanced stage, overall survival and disease-free survival appear to not be affected by treatment center.
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Rivard
authors.affiliation: Guideline Utilization Resource Unit, CancerControl Alberta, Calgary, Alberta, Canada.
authors.forename: Xanthoula
authors.initials: X
authors.lastname: Kostaras
authors.affiliation: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Shea-Budgell
authors.affiliation: Department of Surgery, Western Hospital, Melbourne, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: Chin-Lenn
authors.affiliation: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.|Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: May Lynn
authors.initials: ML
authors.lastname: Quan
authors.affiliation: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.|Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: J Gregory
authors.initials: JG
authors.lastname: McKinnon
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Regional Referral Centre; guideline adherence; melanoma; population-based analysis