title: [Risk characteristics and survival rates of malignant melanoma in Germany and the Netherlands].
abstract: BACKGROUND
  Mortality and lethality of malignant melanoma (MM) show marked variations throughout Europe, thereunder a higher risk within the Netherlands (NL) when compared to Germany (D).
  
  
  OBJECTIVE
  Comparison of systems and exploration of possible causal factors that could explain the difference between D and NL. Comparative healthcare research analysis using published international literature, as well as publicly accessible databases, and a subsequent hypothesis-generating analysis.
  
  
  RESULTS
  The higher rate of excised MM less than 1 mm in diameter in D (65 % vs. 45 %) confirms the clinical reports of the cancer registries. The biological factors for the emergence of MM, such as skin type, do not seem to significantly differ from each other. Among the further potential predictors there are no relevant differences within, for example, geographical conditions and the qualifications of the treating physicians. Primary prevention has a longer continual tradition in D. Here, secondary prevention is characterized by population-based extensive screening, which does not occur within the NL. In addition, distinct differences are found regarding access to dermatologists.
  
  
  CONCLUSIONS
  System access to a medical specialist and the prevention of skin cancer are currently the most distinctive potential determinants of more favorable MM survival rate in Germany.
authors.affiliation: CVderm - Competenzzentrum Versorgungsforschung in der Dermatologie, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland. jo.augustin@uke.de.
authors.forename: J
authors.initials: J
authors.lastname: Augustin
authors.affiliation: CVderm - Competenzzentrum Versorgungsforschung in der Dermatologie, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
authors.forename: I
authors.initials: I
authors.lastname: Schäfer
authors.affiliation: Dermatologische Gemeinschaftspraxis am Tibarg, Institut für Strategische Analysen in der Dermatologie (IStAD), Hamburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Reusch
authors.affiliation: CVderm - Competenzzentrum Versorgungsforschung in der Dermatologie, Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Augustin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate
keywords: Biological Factors; Health Services Research; Primary Prevention; Registries; Secondary Prevention