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Adverse Outcomes Associated with Noncompliance with Melanoma Treatment Guidelines

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Clinical practice guidelines have been developed to improve melanoma patient care. However, it is unclear whether failure to comply with these standards (either excessive or inadequate treatment) increases morbidity or relapse rates. Therefore, we undertook this study to evaluate the effect of variance from National Comprehensive Cancer Network (NCCN) recommendations on postoperative complication rates and disease recurrence.

Methods

We retrospectively reviewed our institutional cancer registry data on 327 clinically node-negative melanoma patients and assessed compliance with NCCN guidelines, complication rates, and outcome. Data were confirmed by chart, pathology report, and operative note review. Statistical analysis was performed by using the SAS statistical software package.

Results

Postoperative complications were documented in 17% of patients and were 3.4-fold higher for patients treated in a margin-noncompliant fashion and 2.4-fold higher for patients treated in a lymph-node-noncompliant manner (P < 0.001 for both). After mean follow-up of 51 months, disease recurred in 58 patients (18%) at a mean of 33 months (range 4–93 months). Locoregional disease alone as the first site of relapse was seen in 24% of margin-noncompliant versus 6% of margin-compliant cases and in 33% of lymph-node-noncompliant versus 6% of lymph-node-compliant cases (P < 0.0001).

Conclusion

While there are valid reasons for variance from treatment algorithms, these data suggest that compliance with NCCN guidelines improves outcome and decreases morbidity in clinically node-negative melanoma patients.

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Acknowledgements

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. We are grateful for the invaluable assistance of Maria Mikhlin and B. Patricia Waldron of the Rush North Shore Medical Center Cancer Registry. Presented as an oral presentation at the Society of Surgical Oncology 61st Annual Cancer Symposium, Chicago, IL, March 14, 2008.

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Authors and Affiliations

  1. Department of Surgery, Rush North Shore Medical Center, 9669 North Kenton, Suite 204, Skokie, IL, 60076, USA

    Jennifer Erickson Foster MD, Josè M. Velasco MD & Tina J. Hieken MD

  2. Rush University Medical Center, Chicago, IL, USA

    Jennifer Erickson Foster MD, Josè M. Velasco MD & Tina J. Hieken MD

  3. Rush Medical College, Chicago, IL, USA

    Jennifer Erickson Foster MD, Josè M. Velasco MD & Tina J. Hieken MD

Authors
  1. Jennifer Erickson Foster MD
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  2. Josè M. Velasco MD
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  3. Tina J. Hieken MD
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Correspondence to Tina J. Hieken MD.

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Erickson Foster, J., Velasco, J.M. & Hieken, T.J. Adverse Outcomes Associated with Noncompliance with Melanoma Treatment Guidelines. Ann Surg Oncol 15, 2395–2402 (2008). https://doi.org/10.1245/s10434-008-0021-0

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  • DOI: https://doi.org/10.1245/s10434-008-0021-0

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