Timeliness of diagnosis and treatment of cutaneous melanoma with dermatology, general practice, plastics surgery collaboration – are we meeting standards?
Haein Na
1 * , Amanda Oakley 2 3
1 Te Whatu Ora Waitematā, 124 Shakespeare Road, Takapuna, Auckland 0620, New Zealand.
2 Te Whatu Ora Waikato, 183 Pembroke Street, Hamilton 3204, New Zealand.
3 Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
Journal of Primary Health Care 15(3) 267-273 https://doi.org/10.1071/HC23013
Published: 26 April 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Melanoma is a serious type of skin cancer with a high burden in New Zealand. MelNet Quality Statements (2021) guide the timeliness of investigations and management for melanoma patients, who might experience long delays waiting for treatment.
Aim: To assess compliance of melanoma diagnosis and treatment timeliness with the MelNet Quality Statements at Waikato Hospital and in primary care for melanoma and melanoma in situ (MIS).
Methods: This is a retrospective clinical audit of patients referred via the Suspected Skin Cancer (SSC) teledermatology pathway between June 2020 and June 2022, and histologically confirmed as having melanoma or MIS. Time intervals between elements of service were analysed.
Results: For 43 melanomas and 105 MIS, compliance with MelNet Quality Statements across all melanoma services was poor, except for teledermatology response rates (100% compliance). From referral to first cancer treatment (Statement 2.1.1), compliance was 50% in general practice and 7.7% in Waikato Hospital. From teledermatologist response to biopsy (Statement 2.1.3), compliance was 65.2% in general practice and 7.7% in hospital plastics department. Histopathological reporting delays were also identified.
Discussion: Long delays for melanoma care in hospital likely reflect system failures (such as inadequate funding and human resources) and the increasing burden of skin cancer. In contrast, primary care provided quicker diagnostic biopsies and surgical treatments for melanoma.
Keywords: cancer treatment, clinical audit, cutaneous melanoma, dermatology, general practice, melanoma, New Zealand, primary care, skin cancer, telemedicine, treatment compliance.
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