title: Comparing initial diagnostic excision biopsy of cutaneous malignant melanoma in primary versus secondary care: A study of Irish National data.
abstract: BACKGROUND
  The incidence of melanoma is rising worldwide. Current Irish guidelines from the National Cancer Control Programme state suspicious pigmented lesions should not be removed in primary care. There are conflicting guidelines and research advising who should remove possible melanomas.
  
  
  OBJECTIVE
  To determine whether initial diagnostic excision biopsy of cutaneous malignant melanoma in primary versus secondary care leads to poorer survival.
  
  
  METHODS
  Analysis of data comprising 7116 cases of cutaneous malignant melanoma from the National Cancer Registry Ireland between January 2002 and December 2011. Single predictor variables were examined by the chi-square or Mann-Whitney U test. The effects of single predictor variables on survival were examined by Cox proportionate hazards modelling and a multivariate Cox model of survival based on excision in a non-hospital setting versus hospital setting was derived with adjusted and unadjusted hazard ratios.
  
  
  RESULTS
  Over a 10-year period 8.5% of melanomas in Ireland were removed in a non-hospital setting. When comparing melanoma death between the hospital and non-hospital groups, the adjusted hazard ratio was 1.56 (95%CI: 1.08-2.26); (P = .02), indicating a non-inferior outcome for the melanoma cases initially treated in the non-hospital group, after adjustment for significant covariates.
  
  
  CONCLUSIONS
  This study suggests that initial excision biopsy carried out in general practice does not lead to a poorer outcome. [Box: see text].
authors.affiliation: a Carrowmullan Fahan Village Co. Donegal , Donegal , Ireland.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Doherty
authors.affiliation: b GP training UHW, University Hospital Waterford , Waterford , Ireland.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Jackman
authors.affiliation: b GP training UHW, University Hospital Waterford , Waterford , Ireland.
authors.forename: John F
authors.initials: JF
authors.lastname: Kirwan
authors.affiliation: b GP training UHW, University Hospital Waterford , Waterford , Ireland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Dunne
authors.affiliation: c Department of Public Health HSE-SE , The Tower St. Canice's Hospital, Lacken Kilkenny , Kilkenny , Ireland.
authors.forename: Kieran G
authors.initials: KG
authors.lastname: O'Connor
authors.affiliation: b GP training UHW, University Hospital Waterford , Waterford , Ireland.
authors.forename: John M
authors.initials: JM
authors.lastname: Rouse
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D005260:Female; D058006:General Practice / Q000379:methods; D006801:Humans; D007494:Ireland; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D016016:Proportional Hazards Models; D012042:Registries; D063127:Secondary Health Care / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D000096142:Cutaneous Malignant Melanoma
keywords: Melanoma; cancer; excision; general practice