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Compliance with Melanoma Treatment Guidelines in a Community Teaching Hospital: Time Trends and Other Variables

  • Melanomas
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Variation in the surgical treatment of melanoma occurs despite efforts to standardize care. This may lead to morbidity, inaccurate staging, and poor outcomes, or it may be cost ineffective. The purpose of our study was to evaluate our institutional compliance with National Comprehensive Cancer Network (NCCN) melanoma treatment guidelines.

Methods

We studied 252 clinically node-negative melanoma patients identified from our cancer registry. Treatment data were confirmed by individual review of pathology and operative reports.

Results

Documented margins of excision conformed to NCCN guidelines in 87% of Tis–T1 tumors and 60% of T2–T4 tumors. Lymph node staging was performed in 11% of T1a, 64% of T1b, 74% of T2, 63% of T3, and 47% of T4 patients. Treatment by a surgical oncologist achieved margin and lymph node compliance in 95% and 92% of cases versus other practitioners in 38% and 67%, respectively (P < .0001). Documented compliance with margin guidelines improved from 46% to 73% for the years 1995 to 1999 versus 2000 to 2004 (P < .0001) and for lymph node staging and treatment from 74% to 84% (P = .04). Other factors associated with greater adherence to NCCN guidelines were patient age <80 years, upper extremity tumors, and thinner tumors (all P < .05).

Conclusions

Our data suggest that our compliance with NCCN melanoma treatment guidelines was suboptimal. Treatment directed by a surgical oncologist showed the highest rate of adherence to national standards. Further investigation is needed to determine the effect of this on patient outcomes and how best to provide high-quality care to the greatest number of melanoma patients.

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Acknowledgments

Supported in part by the Surgical Research Fund of the Rush North Shore Medical Center Department of Surgery and the Department of General Surgery, Rush University Medical Center. Presented as a poster at the Society of Surgical Oncology 60th Annual Cancer Symposium, Washington, DC, March 16, 2007.

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Correspondence to Tina J. Hieken MD.

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Erickson, J.L., Velasco, J.M. & Hieken, T.J. Compliance with Melanoma Treatment Guidelines in a Community Teaching Hospital: Time Trends and Other Variables. Ann Surg Oncol 15, 1211–1217 (2008). https://doi.org/10.1245/s10434-007-9789-6

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  • DOI: https://doi.org/10.1245/s10434-007-9789-6

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