Disparities in the management of cutaneous malignant melanoma. A population‐based high‐resolution study

Abstract

Population‐based cancer registry data from three Spanish areas were used to assess the patterns of care and adherence to guidelines for cutaneous malignant melanoma. We included 934 cases diagnosed in 2009–2013. Completeness of the pathology reports, imaging for detecting distant metastasis and the use of sentinel lymph node biopsy (SLNB) were analysed. The proportion of pathology reports that mentioned the essential pathological features required for T staging was 93%, ranging across geographic areas from 81% to 98% (p < 0.001). The percentage of low‐risk patients who underwent no imaging studies, as proposed by guidelines, or only chest imaging ranged among areas from 0.6% to 84% (p < 0.001). Of the patients with clinically node‐negative melanoma >1 mm thick and no distant metastases, 68% underwent SLNB, varying by area from 61% to 78% (p = 0.017). This study revealed wide geographic variation in different aspects of melanoma care. The use of a standardised structured pathology report could strengthen the completeness of reporting. Improvement strategies should also include efforts to reduce overuse of imaging in low‐risk patients and to increase the adherence to guidelines recommendations on the use of SLNB.

Association of Sentinel Node Biopsy and Pathological Report Completeness with Survival Benefit for Cutaneous Melanoma and Factors Influencing Their Different Uses in European Populations

“…Our results are consistent with those of other studies reporting slightly higher than European mean SLNB frequencies in Spain [ 11 ] and lower ones in Italy [ 29 ]; in both these countries, a remarkable within-country variation in SLNB use was highlighted. In the present study, the large proportion of early-stage melanomas in Spain ( Table 1 ) might explain the overall low odds of SLNB, as well as an RER in line with the European average.…”

“…In our study, SLNB was performed for around 43% of total cases, with notable differences between countries, however, by restricting the analysis to patients with non-metastatic clinically node negative melanoma (cN0M0) with a tumor thickness > 1 mm, for whom the procedure is recommended, the percentage of biopsies rose to almost 70% (69.8%), a figure close to that reported in the US Surveillance Epidemiology and End Results (SEER) in a comparable study period [ 23 ]. Although the intercountry variability in the SLNB use attenuated when considering clinically node-negative cases only, the multivariable analysis confirmed the differences by country, as well as the lower odds of receiving SLNB for elderly than younger patients, a finding reported also by other studies [ 11 , 28 ].…”

“…Differences in the use of SLNB for melanoma evidenced by national population-based studies [ 11 , 12 , 13 ] can be partially attributable to factors such as the distribution of stage, anatomic location, age at diagnosis, comorbidities, clinicians’ expertise, the health system organization, or may also reflect the lack of solid evidence of benefit for this procedure [ 10 ].…”

Cancer Survival in Adults in Spain: A Population-Based Study of the Spanish Network of Cancer Registries (REDECAN)

“…A previous study found regional differences in survival for various cancers in Spain, most notably for lung cancer [36]. Indications that there is room for improvement have been seen in some high-resolution studies showing geographical variation in the early diagnosis and management of cancer patients in Spain [37,38]. Furthermore, some Spanish studies have reported geographical disparities in infrastructure and equipment for radiation oncology, and in access to oncology drugs and predictive biomarkers [39,40].…”

Usefulness of High-Frequency Ultrasonography in the Diagnosis of Melanoma: Mini Review

“…In this study 14 CM have been analyzed. They present oval aspects and a fusiform shape, inhomogeneous, hypoechoic, smooth edges, and variable vascularization (1,47,48).…”