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Jobson D, Roffey B, Arnold C, Azzi A, Button-Sloan A, Dawson T, Fernandez-Penas P, Fishburn P, Gyorki DE, Hiscutt EL, Jakrot V, Lilleyman A, Lochhead A, Long GV, Mailer S, Mann G, McCormack CJ, Muir J, Pratt GF, Scolyer RA, Shackelton M, Shumack S, Soyer HP, Tan CG, Webb A, Zalcberg J, Morton R, Mar V. Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study. Australas J Dermatol 2022; 63:344-351. [PMID: 35486539 DOI: 10.1111/ajd.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/07/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty-six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. METHODS Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two-round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. RESULTS Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. CONCLUSION This study provides a multi-stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).
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Affiliation(s)
- Dale Jobson
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benjamin Roffey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Arnold
- Hodgson Associates, Melbourne, Victoria, Australia.,Biogrid Australia, Parkville, Victoria, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, New South Wales, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Skin Cancer Institute, Singapore City, Singapore.,Skin Cancer College Australasia, Auchenflower, Queensland, Australia.,Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia
| | | | - Tamara Dawson
- Melanoma and Skin Cancer Advocacy Network, Carlton, Victoria, Australia
| | - Pablo Fernandez-Penas
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Paul Fishburn
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Norwest Skin Cancer Centre, New South Wales, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma L Hiscutt
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Valerie Jakrot
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,The University of Sydney, New South Wales, Australia
| | - Alister Lilleyman
- Skin Cancer College Australasia, Auchenflower, Queensland, Australia.,Australian College of Rural and Remote Medicine, Brisbane, Queensland, Australia
| | - Alistair Lochhead
- Southern IML Pathology, Wollongong, New South Wales, Australia.,Department of Anatomical Pathology, Wollongong Hospital, Wollongong, New South Wales, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Mater Hospital, Sydney, New South Wales, Australia
| | - Sonia Mailer
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Melanoma Research Victoria, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Graham Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,The John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher J McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jim Muir
- University of Queensland, Brisbane, Queensland, Australia.,Mater Hospital, Brisbane, Queensland, Australia
| | - George F Pratt
- Plastic and Reconstructive Unit, Monash Health, Dandenong, Victoria, Australia.,Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Shackelton
- Central Clinical School and School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia.,Department of Oncology, Alfred Health, Prahran, Victoria, Australia
| | - Stephen Shumack
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Skin Health Institute, Carlton, Victoria, Australia
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Prahran, Victoria, Australia
| | - Rachael Morton
- Melanoma Institute Australia, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Pellacani G, Farnetani F, Chester J, Kaleci S, Ciardo S, Bassoli S, Casari A, Longo C, Manfredini M, Cesinaro AM, Giusti F, Iacuzio A, Migaldi M. Cutaneous Melanoma Systematic Diagnostic Workflows and Integrated Reflectance Confocal Microscopy Assessed with a Retrospective, Comparative Longitudinal (2009-2018) Study. Cancers (Basel) 2022; 14:cancers14030838. [PMID: 35159105 PMCID: PMC8834176 DOI: 10.3390/cancers14030838] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/05/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023] Open
Abstract
Simple Summary A retrospective study (2009–2018), where the integration of education, a diagnostic-therapeutical workflow (with centralized and immediate assessment of suspicious lesions) and high-performance technology in a single province, seems to improve melanoma detection accuracy, as measured by the number needed to excise. From 40,832 lesions excised there was 279% increase number of melanoma excised. A systemic diagnostic-therapeutical workflow including reflectance confocal micrscopy (RCM) was described. The impact was assessed with the number of lesions needed to excise (NNE) according to excision location: reference hospital (DP) or other (NDP), NNE decreased almost 3-fold at DP and by half at NDP. Aggressive melanoma detection remained unchanged over the study period. Hypothetical cost analyses estimated health service savings. Abstract Background: The increasing global burden of melanoma demands efficient health services. Accurate early melanoma diagnosis improves prognosis. Objectives: To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and high-performance technology integration) and estimate cost savings. Methods: Retrospective analysis of epidemiological data of an entire province over a 10-year period of all excised lesions suspicious for melanoma (melanoma or benign), registered according to excision location: reference hospital (DP) or other (NDP). A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Impact was assessed with the number of lesions needed to excise (NNE). Results: From 40,832 suspicious lesions excised, 7.5% (n = 3054) were melanoma. There was a 279% increase in the number of melanomas excised (n = 203 (2009) to n = 567 (2018)). Identification precision improved more than 100% (5.1% in 2009 to 12.0% in 2018). After RCM implementation, NNE decreased almost 3-fold at DP and by half at NDP. Overall NNE for DP was significantly lower (NNE = 8) than for NDP (NNE = 20), p < 0.001. Cost savings amounted to EUR 1,476,392.00. Conclusions: Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma. Total costs may be reduced by as much as 37%.
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Affiliation(s)
- Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Dermatology Clinic, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
- Correspondence: ; Tel.: +39-33-3485-7774
| | - Johanna Chester
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Shaniko Kaleci
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Silvana Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Sara Bassoli
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Alice Casari
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Caterina Longo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Anna Maria Cesinaro
- Department of Anatomic Pathology, Azienda Ospedaliero—Universitario Modena, 41124 Modena, Italy;
| | - Francesca Giusti
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy; (G.P.); (J.C.); (S.K.); (S.C.); (S.B.); (A.C.); (C.L.); (M.M.); (F.G.)
| | - Antonio Iacuzio
- 5th Engineer Regiment, Italian Army, Macomer, 08100 Nuoro, Italy;
- Department of Anatomic Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Mario Migaldi
- Department of Anatomic Pathology, University of Modena and Reggio Emilia, 41124 Modena, Italy;
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Li Z, Fang Y, Chen H, Zhang T, Yin X, Man J, Yang X, Lu M. Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study. Neoplasia 2022; 24:12-21. [PMID: 34872041 PMCID: PMC8649617 DOI: 10.1016/j.neo.2021.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
This study aimed to estimate the latest magnitudes and temporal trends of melanoma burden at the national, regional, and global levels. The data on melanoma incidence, deaths, and disability-adjusted life-years (DALYs) in 204 countries and territories between 1990 and 2019 came from the Global Burden of Disease 2019 Study. Estimated annual percentage change (EAPC) was calculated to depict the temporal trends and Spearman rank correlation was used to analyze the influential factors of EAPC. From 1990 to 2019, the incident cases of melanoma increased by 170% to 289,950, death increased by 90% to 62,840, and DALYs increased by 67% to 1,707,800 globally. The age-standardized incidence rate (ASIR) of melanoma increased globally by an average of 1.13 [95% confidence interval (CI): 0.93-1.32], while the age-standardized rates of death and DALYs both declined with the EAPC of -0.27 (95% CI: -0.36 to -0.19) and -0.49 (95% CI: -0.57 to -0.41). In 2019, the highest burden of melanoma was observed in Australasia, followed by high-income North America and Europe regions, which all presented an incremental growth in ASIR. The positive association between the EAPC in ASIR and socio-demographic index (SDI) in 2019 (ρ = 0.600, P < 0.001) suggested that countries with higher SDI have experienced a more rapid increase in ASIR of melanoma. In conclusion, the burden of melanoma is increasing globally but differed greatly across the world. Notably, the high burden areas are facing a continuing increase in incidence, which implies more targeted strategies should be taken for reducing the increasing melanoma burden.
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Affiliation(s)
- Zhen Li
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan Fang
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongchao Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaolin Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jinyu Man
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Ming Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China; Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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