Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
World J Surg Oncol. 2012 Apr 6;10:54. doi: 10.1186/1477-7819-10-54.
Recently, a Surveillance Epidemiology and End Results (SEER) survey of melanoma patterns of care by the Mayo Clinic, Scottsdale showed remarkable deviations from best practice patterns throughout the country. The study, which analyzed the SEER records of 35,126 stage I to III cutaneous malignant melanoma patients treated from 2004 to 2006, showed that adherence to National Comprehensive Cancer Network (NCCN) therapeutic resection margins occurred in less than 36% of patients. Similarly, considerable variation in the quality of melanoma care in the United States when assessed using 26 quality indicators drawn by a panel of melanoma experts was independently reported. These observations underscore the significant lack of adherence to published best practice patterns reflected by the NCCN guidelines. The untoward effects of these variations in practice pattern can have an inordinate impact on the survival of melanoma patients in whom long term outcomes are affected by the adequacy of surgical management. Thin malignant melanoma is curable; however, thick or node positive melanoma is often incurable. This outcome is determined not only by the stage at presentation but by the use of best practice patterns as reflected in current NCCN cutaneous melanoma practice guidelines.
最近，梅奥诊所（Mayo Clinic）斯科茨代尔分校（Scottsdale）对黑色素瘤治疗模式进行了一项监测流行病学和最终结果（SEER）调查，结果显示全国各地的治疗模式与最佳实践模式存在显著差异。这项研究分析了 2004 年至 2006 年期间治疗的 35126 例 I 期至 III 期皮肤恶性黑色素瘤患者的 SEER 记录，结果表明，只有不到 36%的患者符合国家综合癌症网络（NCCN）的治疗性切除边缘标准。同样，美国黑色素瘤专家小组根据 26 个质量指标评估了黑色素瘤治疗质量，结果显示存在相当大的差异。这些观察结果强调了 NCCN 指南所反映的对已发表最佳实践模式的明显不遵守。这些实践模式的变化可能会对黑色素瘤患者的生存产生极大的影响，因为长期结果受到手术管理的充分性的影响。薄型恶性黑色素瘤是可治愈的；然而，厚型或淋巴结阳性黑色素瘤通常是不可治愈的。这种结果不仅取决于发病时的阶段，还取决于当前 NCCN 皮肤黑色素瘤实践指南中反映的最佳实践模式的应用。
