Doctors' recognition and management of melanoma patients' risk: An Australian population-based study.
BACKGROUND
Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices.


OBJECTIVE
A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors' knowledge of melanoma patients' risk and to identify factors associated with better identification and clinical management.


METHODS
Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study. This study collected data on all melanoma diagnoses notified to the state's cancer registry during a 12-month period from 2006 to 2007, as well as questionnaire data from the doctors involved in their care.


RESULTS
Three-quarters (74%) of patients had doctors who were aware of their risk factor status with respect to personal and family history of melanoma and the presence of many moles. Doctors working in general practice, skin cancer clinics and dermatology settings had better knowledge of patients' risk factors than plastic surgeons. Doctors were 15% more likely to know the family history of younger melanoma patients (<40years) than of those ≥80 years (95% confidence interval 4-26%). Early detection-related follow-up advice was more likely to be given to younger patients, by doctors aware of their patients' risk status, by doctors practising in plastic surgery, dermatology and skin cancer clinic settings, and by female doctors.


CONCLUSIONS
Both patient-related and doctor-related factors were associated with doctors' recognition and management of melanoma patients' risk and could be the focus of strategies for improving care.
Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia. Electronic address: christine.madronio@sydney.edu.au.
C M
CM
Madronio
Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.
B K
BK
Armstrong
Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia.
C G
CG
Watts
Melanoma Institute Australia, The University of Sydney, North Sydney, Australia.
C
C
Goumas
NHMRC Clinical Trials Centre, The University of Sydney, Australia.
R L
RL
Morton
School of Public Health, Rural Health Northern Rivers, Lismore, Australia.
A
A
Curtin
Discipline of Dermatology, Sydney Medical School, The University of Sydney, Australia; The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia.
S W
SW
Menzies
Melanoma Institute Australia, The University of Sydney, North Sydney, Australia; Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Australia.
G J
GJ
Mann
Melanoma Institute Australia, The University of Sydney, North Sydney, Australia; Central Clinical School, The University of Sydney, Australia.
J F
JF
Thompson
Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia; Melanoma Institute Australia, The University of Sydney, North Sydney, Australia.
A E
AE
Cust
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008545:Melanoma / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D009517:New South Wales; D012307:Risk Factors; D012878:Skin Neoplasms / Q000209:etiology* / Q000628:therapy
Cancer; Guideline adherence; Melanoma; Risk factors