BackgroundFactors associated with non-adherence to guideline-recommended complete excision of suspicious cutaneous lesions are unclear. ObjectiveTo analyse patient, melanoma and clinician factors associated with initial diagnostic biopsy type; and determine whether unwarranted variation from guidelines occurred. MethodsThis population-based, cohort study involved analysis of data from questionnaires completed by clinicians who managed patients with newly-diagnosed, histopathologically-confirmed primary invasive cutaneous melanomas reported to the NSW Cancer Registry between 2006-2007. ResultsOf 2267 biopsies, complete excision was attempted in 69.1% of cases, but histologically incomplete in 14.0%. Multivariable regression analyses showed complete excision was more likely than: incision biopsy in patients <70years (p=0.016); shave biopsy in patients <80years (p=0.034); shave biopsy in melanomas of Breslow thickness 0.8-1.0mm or 2.1-4.0mm (p=0.039); than either punch (p<0.001) or shave biopsy (p<0.003) in melanomas on trunk or limbs; and punch biopsy when treated by a surgeon (p<0.001). Complete excision was less likely than: punch biopsies in females (p<0.003); with LMM or unknown histopathology (p=0.004); shave biopsy in patients with LMM, or other melanoma subtype (p=0.003); punch, shave or incision biopsy when treated by a dermatologist (p<0.001). LimitationsGeneralisability of these findings may be limited to the time of data collection. ConclusionGuideline adherence for biopsy type undertaken for clinically suspected melanoma appeared to be sub-optimal.
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