Oral 02. 9.10am
Missed Opportunities for Melanoma Detection in Secondary Care
Authors: C. Quinlan1, S. McCracken2, E.Tierney1, C. Heffron3, J. Fitzgibbon3, C. Murphy2,4, J.F. Bourke1, M. Murphy1,2
Affiliations:
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork
- School of Medicine, University College Cork
- Department of Histopathology, Cork University Hospital, Cork
- Department of Medical Oncology, Bon Secours Hospital, Cork
Introduction: Early detection of melanoma is associated with improved survival.1+2 There has been significant emphasis on the role of general practitioners in melanoma screening strategies.3-6 However, the role of secondary care providers in the detection of melanoma has been rarely explored.
Aim: To identify inpatient and outpatient episodes in patients with intermediate and thick melanomas in the 5 years and 1 year prior to their diagnosis.
Methods: A multicentre, retrospective case review was conducted at Cork University Hospital, South Infirmary Victoria University Hospital Cork, Mercy University Hospital Cork, Bon Secours Hospital Cork and University Hospital Kerry. Databases at the five hospitals were reviewed. All patients with a Cork/Kerry address with primary cutaneous melanomas of greater than or equal to 1mm Breslow depth from January 2013 to December 2014 diagnosed or reviewed by CUH pathology department were included. Data from the patient record enquiry for the 5 years prior to diagnosis was collected for each patient at each clinical site. This included inpatient admissions, day case admissions, outpatient clinics and emergency department attendances.
Results: 106 patients were included with a mean age of 63 years. The median Breslow depth was 2.3mm. 32 (30%) of the melanomas were located on the head/neck region. Of the 106 patients, 67% (n=71) had a secondary care interaction in the 5 years prior to their melanoma diagnosis and 42.5% (n=45) in the year prior to diagnosis. Most of these hospital encounters were in the outpatient clinic (57.5%), but almost one third (31%) had an inpatient admission in the five years prior to diagnosis and 10%(n=11) in the year prior to diagnosis.
The three specialties with the most interactions in the year prior to diagnosis were ophthalmology (n=20), orthopaedics (n=18) and emergency medicine (n=16).
Discussion: A significant opportunity exists to improve early detection of intermediate and thick melanomas in secondary care. Patients with intermediate and thick melanomas are being seen in secondary care facilities in the years prior to their diagnosis. Education and awareness campaigns directed at secondary care providers should be implemented to encourage them to perform skin assessment as part of clinical examination.
References:
1. Marks. R. Prevention and Control of Melanoma; The Public Health Approach. Ca Cancer J Clin.1996:46; 199-216
2.Schuchter. L. et al. A prognostic model for predicting 10-year survival in patients with primary melanoma.Annals of Internal medicine. 1996;125(5):369-75
3. Baade. P.D. et al The relationship between melanoma thickness and time to diagnosis in a large population-based study.Archives of dermatology. 2006;142(11):1422-7
4. Richard. M.A. et al Delays in diagnosis and melanoma prognosis (II):the role of doctors. International journal of cancer. 2000;89(3):280-5
5. Argenziano. G. et al. Total body skin examination for skin cancer screening in patients with focused symptoms. J Am AcadDermatol. 2012;66(2):212-9
6. Aitken. J.F. et al. Clinical whole body skin examination reduces the incidence of thick melanomas. International journal of cancer. 2010;126(2):450-8