SCARD Posts

Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined.

Authors: Clara Jimenez Balcells, Jeremy Hay, Jeff Keir, 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

ABSTRACT

Background and Objective
Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined.

Patients and Methods
Six hundred and thirty-seven melanomas treated by 27 Australasian GPs during 2013 and documented on the Skin Cancer Audit Research Database (SCARD) were analysed by anatomical site, subtype, Breslow thickness, diameter, associated naevi and linked adverse outcomes.

Results
Most melanomas (59.7%) were on males, mean age at diagnosis being 62.7 years (range 18–96). Most (65.0%) were in situ, with a high incidence of lentiginous melanoma (LM) (38.8%) and 32% were naevus associated. Most LM (86.4%) were in situ, compared to 55% of superficial spreading melanoma (SSM) (P < 0.0001). There was male predominance on the head, neck and trunk and female predominance on extremities. There was no significant association between Breslow thickness and diameter, with small melanomas as likely to be thick as large melanomas, and melanomas ≤3 mm diameter, on average, more likely to be invasive than larger melanomas. There was a positive correlation between age and both melanoma diameter and Breslow thickness. Seven cases progressed to melanoma-specific death: Five nodular melanoma (NM) and two SSM, one of which was thin (Breslow thickness 0.5 mm).

Conclusions
A large series of melanomas treated by Australasian GPs were predominantly in situ, with a high proportion of LM subtype. With implications for GP training, NM linked to death was over-represented and there was a novel finding that older patients had larger diameter melanomas.

Dermatoscopy has undoubtedly advanced the diagnostic accuracy of pigmented and non-pigmented skin lesions. Pattern analysis is the most powerful of current methods for dermatoscopic diagnosis, but it does present significant challenges to the learning dermatoscopist.

We present here an algorithmic method, derived from pattern analysis, based on logical analysis of simply defined geometric features. We consider this presents fewer barriers to the beginner, but retains sufficient power for the most experienced user. Most importantly, it provides a better framework for elevating experience beyond mere anecdotes, allowing the experience to lead to true expertise.

Links

You can view the full paper online at https://onlinelibrary.wiley.com/doi/10.1111/ajd.13705

Keywords

melanomas, general practitioners, Australasian GPs, pigmented, non-pigmented, skin cancer, algorithm, white circles, keratin, vessels