Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database

Jeremy Hay; Jeff Keir; Clara Jimenez Balcells; Nikita Rosendahl; Martelle Coetzer-Botha; Tobias Wilson; Simon Clark; Astrid Baade; Cath Becker; Luke Bookallil; Chris Clifopoulos; Tony Dicker; Martin Paul Denby; Douglas Duthie; Charles Elliott; Paul Fishburn; Mark Foley; Mark Franck; Irene Giam; Patricio Gordillo; Alister Lilleyman; Roger Macauley; James Maher; Ewen McPhee; Michael Reid; Bob Shirlaw; Graeme Siggs; Robert Spark; John Stretch; Keith van Den Heever; Thinus van Rensburg; Chris Watson; Harald Kittler; Cliff Rosendahl

doi:10.1111/ajd.13843

Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database

Australas J Dermatol. 2022 May;63(2):204-212. doi: 10.1111/ajd.13843. Epub 2022 Apr 19.

Authors

Jeremy Hay¹, Jeff Keir², Clara Jimenez Balcells³, Nikita Rosendahl⁴, Martelle Coetzer-Botha², Tobias Wilson⁵, Simon Clark^{4

6}, Astrid Baade⁷, Cath Becker^{8

9}, Luke Bookallil¹⁰, Chris Clifopoulos², Tony Dicker², Martin Paul Denby¹¹, Douglas Duthie¹², Charles Elliott¹³, Paul Fishburn², Mark Foley¹⁴, Mark Franck¹⁵, Irene Giam¹⁶, Patricio Gordillo¹⁷, Alister Lilleyman¹⁸, Roger Macauley¹⁹, James Maher²⁰, Ewen McPhee²¹, Michael Reid²², Bob Shirlaw²³, Graeme Siggs²⁴, Robert Spark²⁵, John Stretch²⁶, Keith van Den Heever²⁷, Thinus van Rensburg²⁸, Chris Watson²⁹, Harald Kittler³⁰, Cliff Rosendahl^{2

6}

Affiliations

¹ Upper Hutt Skin Clinic, Upper Hutt, Wellington, New Zealand.
² General Practice Clinical Unit, Medical School, The University of Queensland, Australia.
³ 4D Skin Cancer Clinic, Belmont North, New South Wales, Australia.
⁴ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁵ SCARD, Brisbane, Queensland, Australia.
⁶ Tehran University of Medical Sciences, Tehran, Iran.
⁷ Gladstone GP Superclinic, Gladstone, Queensland, Australia.
⁸ Wairarapa Skin Clinic, Masterton, New Zealand.
⁹ Wairarapa Hospital, Lansdowne, Masterton, New Zealand.
¹⁰ The University of New England, Armidale, New South Wales, Australia.
¹¹ Silverdale Medical, Silverdale, Auckland, New Zealand.
¹² Darwin Skin Cancer Clinic, Parap, Northwest Territories, Australia.
¹³ Solarderm Skin Cancer Practice, Caboolture, Queensland, Australia.
¹⁴ The Skin Clinic, Marlborough - Blenheim, New Zealand.
¹⁵ MoleSafe Skin Cancer Clinic, Windsor, Victoria, Australia.
¹⁶ Skin2 Clinic, Deakin, Australian Capital Territory, Australia.
¹⁷ Cairns Skin Cancer Clinic, Cairns, Queensland, Australia.
¹⁸ Newcastle Skin Check, Charlestown, New South Wales, Australia.
¹⁹ Bateau Bay Medical Centre, Bateau Bay, New South Wales, Australia.
²⁰ Skin Cancer Ballarat, Alfredton, Victoria, Australia.
²¹ Emerald Medical Group, Emerald, Queensland, Australia.
²² Nelson Bay Skin Cancer Clinic, Nelson Bay, New South Wales, Australia.
²³ Lakeside Medical, Springfield Lakes, Queensland, Australia.
²⁴ Regency Medical Clinic, Sefton Park, South Australia, Australia.
²⁵ Toukley Family Practice, Toukley, New South Wales, Australia.
²⁶ Bond University, Robina, Queensland, Australia.
²⁷ CQ Skin Cancer Clinic, Bucasia, Queensland, Australia.
²⁸ Kippax Ochre Medical Centre, Holt, Australian Capital Territory, Australia.
²⁹ Brisbane City Doctors, Brisbane, Queensland, Australia.
³⁰ Vienna Dermatologic Imaging Research Group, Department of Dermatology, Medical University of Vienna, Vienna, Austria.

Abstract

Background and objective: General practitioners manage more melanomas than dermatologists or surgeons in Australia. Previously undescribed, the management and outcomes of melanoma patients treated by multiple Australasian general practitioners are examined.

Methods: The characteristics, management and outcomes of 589 melanoma patients, managed by 27 Australasian general practitioners and documented on the Skin Cancer Audit Research Database (SCARD), were analysed.

Results: Most patients (58.9%) were males with mean age at diagnosis of 62.7 years (range 18-96), and most melanomas were in situ or thin-invasive. Patients aged under 40 years had fewer melanomas, but a higher proportion (the majority) were invasive, compared with older patients (P < 0.0001). Most (55.9%) melanomas were diagnosed following elliptical excision biopsy, the rate of unintended involved margins being eightfold higher for shave biopsies. Wide re-excision was performed by the treating general practitioner for most (74.9%) melanomas, with thick melanomas preferentially referred to surgeons. The average Breslow thickness of invasive melanomas re-excised by general practitioners was 0.67 mm compared with 1.99 mm for those referred to other specialists (P < 0.0001). Of 205 patients with invasive melanoma, 14 progressed to metastatic disease, 50% of these being associated with nodular melanoma. Nine patients progressed to melanoma-specific death. The 5-year survival rate for patients with invasive melanoma was 95.2% (95% CI: 91.2-98.5%).

Conclusions: Diagnostic and therapeutic management of a series of melanoma patients by Australasian general practitioners were closely aligned with current guidelines and 5-year survival with respect to invasive melanoma was at least as favourable as national population-based metrics.

Keywords: SCARD; general practice; general practitioner; melanoma; melanoma 5-year survival; melanoma management; melanoma outcomes; primary care.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
General Practitioners*
Humans
Male
Melanoma* / diagnosis
Melanoma* / surgery
Melanoma, Cutaneous Malignant
Middle Aged
Retrospective Studies
Skin Neoplasms* / diagnosis
Skin Neoplasms* / surgery
Treatment Outcome
Young Adult