Authors' response to Diagnostic biopsy of melanoma: primary or secondary care? Mortality and morbidity after initial diagnostic excision biopsy of cutaneous melanoma in primary versus secondary care

Peter Murchie, E Amalraj Raja, Amanda J Lee, Neil C Campbell

Research output: Contribution to journalComment/debate

Abstract

We disagree with the correspondents’ comment that, since the mean thickness
in both the primary and secondary care groups was ≤1mm, mortality and morbidity are not particularly relevant endpoints. We presented median and not mean values in our paper. In fact, over 40% of the lesions in each group of our study had a Breslow thickness ≥1mm. Furthermore, patients can die from melanoma irrespective of the Breslow thickness of the primary lesion, so
mortality was the most appropriate primary outcome for our study. Similarly, morbidity, in this case, subsequent hospital attendances, must be included in any analysis where questions of surgical competence are being addressed.
We salute the excellent model of care that the corresponders are advocating, and
implementing. However, they do not appear to provide any evidence as to why high quality skin biopsy of suspicious pigmented lesions in primary care could not be incorporated. We re-assert our conclusion that our study clearly signifies the need for a randomised controlled trial to establish the role of initial excision biopsy in primary care in the diagnosis and treatment of cutaneous melanoma in the UK. In the long run, this may be beneficial for both patients and the NHS.
Original languageEnglish
Pages (from-to)14
JournalThe British Journal of General Practice
Volume64
Issue number618
DOIs
Publication statusPublished - 1 Jan 2014

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Secondary Care
Melanoma
Primary Health Care
Morbidity
Biopsy
Skin
Mortality
Mental Competency
Randomized Controlled Trials
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • Female
  • Humans
  • Male
  • Melanoma
  • Skin Neoplasms

Cite this

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title = "Authors' response to Diagnostic biopsy of melanoma: primary or secondary care?: Mortality and morbidity after initial diagnostic excision biopsy of cutaneous melanoma in primary versus secondary care",
abstract = "We disagree with the correspondents’ comment that, since the mean thicknessin both the primary and secondary care groups was ≤1mm, mortality and morbidity are not particularly relevant endpoints. We presented median and not mean values in our paper. In fact, over 40{\%} of the lesions in each group of our study had a Breslow thickness ≥1mm. Furthermore, patients can die from melanoma irrespective of the Breslow thickness of the primary lesion, somortality was the most appropriate primary outcome for our study. Similarly, morbidity, in this case, subsequent hospital attendances, must be included in any analysis where questions of surgical competence are being addressed.We salute the excellent model of care that the corresponders are advocating, andimplementing. However, they do not appear to provide any evidence as to why high quality skin biopsy of suspicious pigmented lesions in primary care could not be incorporated. We re-assert our conclusion that our study clearly signifies the need for a randomised controlled trial to establish the role of initial excision biopsy in primary care in the diagnosis and treatment of cutaneous melanoma in the UK. In the long run, this may be beneficial for both patients and the NHS.",
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TY - JOUR

T1 - Authors' response to Diagnostic biopsy of melanoma: primary or secondary care?

T2 - Mortality and morbidity after initial diagnostic excision biopsy of cutaneous melanoma in primary versus secondary care

AU - Murchie, Peter

AU - Raja, E Amalraj

AU - Lee, Amanda J

AU - Campbell, Neil C

PY - 2014/1/1

Y1 - 2014/1/1

N2 - We disagree with the correspondents’ comment that, since the mean thicknessin both the primary and secondary care groups was ≤1mm, mortality and morbidity are not particularly relevant endpoints. We presented median and not mean values in our paper. In fact, over 40% of the lesions in each group of our study had a Breslow thickness ≥1mm. Furthermore, patients can die from melanoma irrespective of the Breslow thickness of the primary lesion, somortality was the most appropriate primary outcome for our study. Similarly, morbidity, in this case, subsequent hospital attendances, must be included in any analysis where questions of surgical competence are being addressed.We salute the excellent model of care that the corresponders are advocating, andimplementing. However, they do not appear to provide any evidence as to why high quality skin biopsy of suspicious pigmented lesions in primary care could not be incorporated. We re-assert our conclusion that our study clearly signifies the need for a randomised controlled trial to establish the role of initial excision biopsy in primary care in the diagnosis and treatment of cutaneous melanoma in the UK. In the long run, this may be beneficial for both patients and the NHS.

AB - We disagree with the correspondents’ comment that, since the mean thicknessin both the primary and secondary care groups was ≤1mm, mortality and morbidity are not particularly relevant endpoints. We presented median and not mean values in our paper. In fact, over 40% of the lesions in each group of our study had a Breslow thickness ≥1mm. Furthermore, patients can die from melanoma irrespective of the Breslow thickness of the primary lesion, somortality was the most appropriate primary outcome for our study. Similarly, morbidity, in this case, subsequent hospital attendances, must be included in any analysis where questions of surgical competence are being addressed.We salute the excellent model of care that the corresponders are advocating, andimplementing. However, they do not appear to provide any evidence as to why high quality skin biopsy of suspicious pigmented lesions in primary care could not be incorporated. We re-assert our conclusion that our study clearly signifies the need for a randomised controlled trial to establish the role of initial excision biopsy in primary care in the diagnosis and treatment of cutaneous melanoma in the UK. In the long run, this may be beneficial for both patients and the NHS.

KW - Female

KW - Humans

KW - Male

KW - Melanoma

KW - Skin Neoplasms

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DO - 10.3399/bjgp14X676311

M3 - Comment/debate

VL - 64

SP - 14

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

IS - 618

ER -