Division of Applied Health Science, University of Aberdeen.
Br J Gen Pract. 2013 Aug;63(613):e563-72. doi: 10.3399/bjgp13X670697.
Current UK melanoma guidelines do not support the initial diagnostic excision biopsy of pigmented lesions in primary care, although this is standard in other countries such as Australia. Previous research in Northeast Scotland found that initial diagnostic excision biopsies in primary care that prove to be melanoma were no more likely to be incomplete than those performed in secondary care, but data on longer-term outcomes were not available.
To determine whether initial diagnostic excision biopsy of cutaneous melanoma in primary versus secondary care leads to poorer survival and increased morbidity.
Analysis of a linked dataset comprising pathological data from melanoma cases diagnosed in Northeast Scotland between 1991 and 2007, the General Registry Office (Scotland) death registry, and an NHS Scotland episode of care database.
Patient data from three sources were matched using the Community Health Index (CHI) number. Cox proportional hazards regression, with robust standard error estimates, was used to examine the hazard ratio (95% confidence interval) of key mortality and morbidity outcomes based on excision in primary versus secondary care. Analysis was conducted before and after adjustment for operator and patient-level factors, using a multilevel approach.
Patients receiving their initial diagnostic excision biopsy for melanoma in primary versus secondary care were no more likely to be dead, or to have died of metastatic malignant melanoma. Patients who had their initial diagnostic excision biopsy for melanoma in primary care had significantly fewer subsequent hospital admissions and spent fewer days in hospital.
These findings suggest that initial diagnostic excision biopsy of melanoma in primary care does not lead to poorer long-term outcomes.
目前英国的黑色素瘤指南不支持在初级保健中对色素性病变进行初始诊断性切除活检，尽管在澳大利亚等其他国家这是标准做法。苏格兰东北部的先前研究发现，在初级保健中进行的初始诊断性切除活检，如果证实为黑色素瘤，则与在二级保健中进行的切除活检相比，其不完全性的可能性并无差异，但没有关于长期结果的数据。
确定在初级保健与二级保健中对皮肤黑色素瘤进行初始诊断性切除活检是否会导致生存率降低和发病率增加。
对包括 1991 年至 2007 年在苏格兰东北部诊断的黑色素瘤病例的病理数据、苏格兰一般登记处（苏格兰）死亡登记处以及苏格兰国民保健制度（NHS Scotland）的一次护理数据库在内的链接数据集进行分析。
使用社区健康索引（CHI）号对来自三个来源的患者数据进行匹配。使用 Cox 比例风险回归，使用稳健标准误差估计，根据在初级保健与二级保健中进行的切除情况，检查关键死亡率和发病率结局的风险比（95%置信区间）。使用多层次方法，在调整操作者和患者水平因素之前和之后进行分析。
在初级保健中接受初始诊断性切除活检的黑色素瘤患者与在二级保健中接受该治疗的患者相比，其死亡或死于转移性恶性黑色素瘤的风险无显著差异。在初级保健中接受初始诊断性切除活检的黑色素瘤患者随后的住院次数和住院天数明显减少。
这些发现表明，在初级保健中对黑色素瘤进行初始诊断性切除活检不会导致长期预后恶化。
