Family Practice Advance Access originally published online on June 23, 2008
Family Practice 2008 25(4):221-227; doi:10.1093/fampra/cmn036
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision
a Department of Primary Care and Public Health, North Wales Clinical School/School of Medicine, Cardiff University, Wrexham Technology Park, Wrexham LL13 7YP
b Department of Primary Care and Public Health
c South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionydd, Heath Park, Cardiff CF14 4YS
d Department of Dermatology, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD
e Cancer Services, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD
f National Public Health Service for Wales, Preswylfa, Hendy Road, Mold, Flintshire CH7 1PZ
g Department of Audit, Research and Effectiveness, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, UK
Correspondence to Richard D Neal, Department of Primary Care and Public Health, North Wales Clinical School/School of Medicine, Cardiff University, Wrexham Technology Park, Wrexham LL13 7YP, UK; Email: nealrd{at}cf.ac.uk
Received 31 January 2008; Accepted 26 May 2008.
 |
Abstract |
|---|
Background. The epidemiology of melanoma is changing and its current management is variable, with some lesions being removed in general practice. We aimed to determine the quality of excision and time to diagnosis relating to the excising surgeon and the place of excision.
Method. Analysis of data from the North Wales Melanoma Database.
Results. In total, 578 cases were diagnosed 1993–2001. There was a gender difference with anatomical location, with 107 (65%) males with lesions on their trunk compared to 57 (35%) females. Median Breslow thickness was 1.10 mm (range 0.05–16.0 mm). Ninety-five (16%) lesions were removed in general practice, of which 49 (52%) were referred on to hospital. In total, 266 (61%) lesions were excised with ‘adequate’ margins and 170 (39%) excised with margins narrower than the guidelines. General practice excisions were from a younger group than hospital excisions. There were no differences in quality of excision between general practice and hospital excisions. Time to diagnosis was shorter overall for general practice excisions than hospital excisions (median 12 versus 41 days, P < 0.001).
Conclusion. These findings are of policy importance in that there is no evidence from this study that general practice excisions are managed poorly or have a worse prognosis.
Keywords. Breslow thickness, diagnostic delays, general practice, melanoma, quality of excision.
Neal RD, Cannings-John R, Hood K, Sowden J, Lawrence H, Jones C and Jones J. Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision. Family Practice 2008; 25: 221–227.