Variations in Management of Stage I to Stage III Cutaneous Melanoma

It is quite surprising how aggressive the French are in managing melanoma with much use of interferon, gretter scanning and investigation and use of sentinel lymph node biopsy examination.

Variations in Management of Stage I to Stage III Cutaneous Melanoma
A Population-Based Study of Clinical Practices in France

Florent Grange, MD, PhD; Fabien Vitry, MD; Florence Granel-Brocard, MD; Dan Lipsker, MD, PhD; Francois Aubin, MD, PhD; Guy Hédelin, PhD; Sophie Dalac, MD; François Truchetet, MD; Catherine Michel, MD; Marie-Laure Batard, MD; Béatrice Baury, PhD; Jean-Michel Halna, MD; Jean Luc Schmutz, MD; Christian Delvincourt, MD; Georges Reuter, MD; Stéphane Dalle, MD; Phillipe Bernard, MD, PhD; Arlette Danzon, MD


Arch Dermatol. 2008;144(5):629-636.

Objective To describe current management of cutaneous melanoma (CM) and identify factors accounting for disparities.

Design Retrospective population-based study using survey of cancer registries and pathology laboratories, and questionnaires to physicians.

Setting Five regions covering 19.2% of the French territory and including 8.2 million inhabitants.

Patients Incident cases of patients with stage I to stage II (hereinafter, stage I-II) tumors staged according to the American Joint Committee on Cancer Staging guidelines and nodal stage III CM in 2004.

Main Outcome Measures Modalities of diagnosis and excision, surgical margins, sentinel lymph node biopsy, adjuvant therapies and surveillance procedures, and their variations according to age, sex, residence, location of primary CM, Breslow thickness, type of physicians, modalities of decisions, and health care patterns.

Results Clinical stage I-II CMs (n = 710 cases) slightly predominated in females (53%), with a lower mean Breslow thickness (1.4 mm) than in males (1.9 mm). Initial excisions were most often performed by private dermatologists and wide excisions by surgeons. Narrow margins (8%) were associated with advanced age, higher Breslow thickness, and head location. Sentinel lymph node biopsy was performed in 34% of CMs thicker than 1.0 mm, depending on geographical regions, distance from reference centers, and health care patterns. Adjuvant therapies (mainly low-dose interferon) were proposed in 53% of thick CMs (>1.5 mm), depending on the patient's age and geographical region. In contrast with French recommendations, surveillance procedures frequently included systematic medical imaging. Stage III nodal CMs (n = 89 cases) predominated in males (62%). After lymphadenectomy, adjuvant therapies (including high-dose interferon in 32% of cases and chemotherapies in 24% of cases) were proposed in 68% of cases, depending on the patient's age and geographical region. A complete 1-year high-dose interferon regimen was administered in less than 10% of cases.

Conclusion Large disparities still exist in the management of CM in France, depending to a greater extent on medical and geographical environment than on the characteristics of either patients or tumors.

Utility of Lesion Diameter in the Clinical Diagnosis of Cutaneous Melanoma

Utility of Lesion Diameter in the Clinical Diagnosis of Cutaneous Melanoma
Naheed R. Abbasi, MPH, MD; Molly Yancovitz, MD; Dina Gutkowicz-Krusin, PhD; Katherine S. Panageas, DrPH; Martin C. Mihm, MD; Paul Googe, MD; Roy King, MD; Victor Prieto, MD; Iman Osman, MD; Robert J. Friedman, MD; Darrell S. Rigel, MD; Alfred W. Kopf, MD; David Polsky, MD, PhD


Arch Dermatol. 2008;144(4):469-474.

Objective To determine the utility of the current diameter criterion of larger than 6 mm of the ABCDE acronym for the early diagnosis of cutaneous melanoma.

Design Cohort study.

Setting Dermatology hospital-based clinics and community practice offices.

Patients A total of 1323 patients undergoing skin biopsies of 1657 pigmented lesions suggestive of melanoma.

Main Outcome Measure The maximum lesion dimension (diameter) of each skin lesion was calculated before biopsy using a novel computerized skin imaging system.

Results Of 1657 biopsied lesions, 853 (51.5%) were 6 mm or smaller in diameter. Invasive melanomas were diagnosed in 13 of 853 lesions (1.5%) that were 6 mm or smaller in diameter and in 41 of 804 lesions (5.1%) that were larger than 6 mm in diameter. In situ melanomas were diagnosed in 22 of 853 lesions (2.6%) that were 6 mm or smaller in diameter and in 62 of 804 lesions (7.7%) that were larger than 6 mm in diameter.

Conclusion The diameter guideline of larger than 6 mm provides a useful parameter for physicians and should continue to be used in combination with the A, B, C, and E criteria previously established in the selection of atypical lesions for skin biopsy.