title: Diagnosis and clinical management of melanoma patients at higher risk of a new primary melanoma: A population-based study in New South Wales, Australia.
abstract: OBJECTIVE
  To describe the method of diagnosis, clinical management and adherence to clinical practice guidelines for melanoma patients at high risk of a subsequent primary melanoma, and compare this with melanoma patients at lower risk.
  
  
  METHODS
  The Melanoma Patterns of Care study was a population-based, observational study based on doctors' reported clinical management of melanoma patients in New South Wales, Australia, diagnosed with in situ or invasive melanoma over a 12-month period from October 2006. Of 2605 patients with localised melanoma, 1019 (39%) were defined as at higher risk due to the presence of one or more of the following factors: a family history of melanoma (11%), multiple primary melanomas (17%), or many naevi (24%).
  
  
  RESULTS
  Compared to patients at lower risk, high risk patients were more likely to receive their initial care from a primary care physician (56% vs 50%, P = 0.002), have their melanoma detected during a routine skin check (40% vs 33%, P < 0.001), have their lesion assessed with dermoscopy (63% vs 56%, P = 0.002), and be encouraged to have skin surveillance (84% vs 77%, P < 0.001) and skin self-examination (87% vs 83%, P = 0.03). Higher socioeconomic status and urban residence were associated with patients at higher risk receiving initial treatment from a specialist doctor.
  
  
  CONCLUSIONS
  Clinical management of higher risk patients was more likely to conform to clinical practice guidelines for diagnosis and skin surveillance than to melanoma patients at lower risk.
authors.affiliation: Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Caroline G
authors.initials: CG
authors.lastname: Watts
authors.affiliation: Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Madronio
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Morton
authors.affiliation: Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Goumas
authors.affiliation: Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Armstrong
authors.affiliation: School of Public Health, Rural Health Northern Rivers, Lismore, New South Wales, Australia.
authors.forename: Austin
authors.initials: A
authors.lastname: Curtin
authors.affiliation: Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Discipline of Dermatology, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Menzies
authors.affiliation: Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.|Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia.
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Mann
authors.affiliation: Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.affiliation: Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.|Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Cust
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology / Q000592:standards; D046169:Dermoscopy; D059026:Diagnostic Self Evaluation; D005260:Female; D058006:General Practice / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*; D009506:Nevus / Q000175:diagnosis*; D009517:New South Wales; D010808:Physical Examination; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D012959:Socioeconomic Factors
keywords: dermoscopy; diagnosis; follow up; guidelines; high risk; melanoma; risk; skin self-examination; surveillance