This study up to the end of 2003 indicates the rising importance of skin cancer clinics in early diagnosis of melanoma in Queensland. That role has probably massively increased since then. Does anyone know if the thickness at diagnosis of melanoma in rural Qld is markedly different from the cities? IMCC
Clinical pathways to diagnose melanoma: a population-based study.
ORIGINAL ARTICLES
Melanoma Research. 17(4):243-249, August 2007.
Baade, Peter D.; Youl, Philippa H.; English, Dallas R.; Mark Elwood, J.; Aitken, Joanne F.
Abstract:
To better understand the clinical diagnostic process for invasive melanoma in Queensland. Descriptive population-based study of Queensland residents (n=3772) aged 20-75 years diagnosed with invasive melanoma between January 2000 and December 2003. Information was obtained via telephone interview combined with pathology data from the Queensland Cancer Registry. About 85% of melanoma patients diagnosed in Queensland saw a general practitioner at least once during the process, most of these for the initial consultation. Almost one-fifth of patients (18.1%) saw a skin clinic doctor sometime through the diagnosis pathway; this proportion increased significantly over the study period (P<0.001). The most common pathway for diagnosing melanoma was an initial consultation by a general practitioner followed by referral to a surgeon for a definitive diagnosis. People living in southeast Queensland were more likely to see a dermatologist compared with those living in more rural or remote areas (14.7 versus 6.8%), more likely to see a skin clinic doctor (21.8 versus 7.2%), or a surgeon (54.9 versus 49.3%) at least once during the diagnostic process, and less likely to see a general practitioner (76.8 versus 90.2%). This descriptive study has demonstrated the complexity and diversity of clinical diagnostic pathways for melanoma in Queensland, highlighting the important role of general practitioners and the emerging role of primary care skin clinics. Although this system has resulted in a very favourable thickness distribution for diagnosed melanomas, access issues for people living in rural and remote areas of Queensland need to be addressed.
7 comments:
Be interesting if they were able to include MM in situ in the study...
I am sure melanoma in situ would have to have been included in this study Jeff.If anyone is able to access the study details I would be grateful.
"Descriptive population-based study of Queensland residents (n=3772) aged 20-75 years diagnosed with invasive melanoma between January 2000 and December 2003"
Not so sure about the inclusion of MMis from the above, Ian.
Isnt MMIS excluded from the cancer registry ? Indeed the population is INVASIVE melanoma.
I would speculate that more MMIS are found within the SCSA audit study then the wider population attending all practitioners.
It would be interesting to see the annual trends for skin clinics by melanoma type over thye last 5 years.
The number of Medicare claims made in Queensland for the treatment of Melanoma in the period in question (Jan 2000-Dec 2003) was 23,412. That is a major discrepancy from the numbers quoted in this survey. Maybe nearly 20,000 MIS ratio 6 MMIS to one invasive. ??!
Does anyone know if the paper breaks down diagnosis on basis of found by patient vs found by doctor.
The vast majority of my melanomas are NOT lesions that patients bring to me; they are either totally unaware the lesion is there, or unaware that it might be a problem.
I'm sure it's the same for most bloggers, how do we compare I wonder.
I m looking at the trends in depth by region fior each state.
Problems arising in analysis are that in NSW melanomas codes as "local" regional "distant" nto your regular Breslow or Clarke. NOw whose idea wa that.
What the preliminary data show for WA is a flat tren over time in rural but a rising proportion of MMIS in the last few yrs.
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