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2010 Annual Meeting Abstracts

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Outcomes for Treatment of Malignant Melanoma in Maine
*Traci Kruse, Lisa Rutstein
Maine Medical Center, Portland, ME

Objective:
Our main objective was to analyze Maine state melanoma data and to draw specific conclusions related to stage at diagnosis, nodal evaluation, adjuvant therapy, recurrence and survival.

Design:
Cohort Study

Setting:
The setting involves physician staff performing an initial biopsy (PCP, dermatologist, surgeon) and those involved in surgical staging and treatment of melanoma (general/oncologic/plastic surgery, medical oncology).

Patients:
Those in the American Cancer Society Database for the state of Maine during 2004-2005.
Those in the Maine Medical Center (MMC) Cancer Registry between 1998 and 2008.

Interventions:
There were no interventions.

Main Outcome Measures:
The outcome measures researched were stage at diagnosis, nodal evaluation by patient stage, and adjuvant therapy decision. As the state database does not collect data on recurrence and survival, we used Maine Medical Center and a surrogate, comparing their recurrence and survival rates to national rates.

Results:
Melanoma is found ubiquitously throughout the state. In Maine, 73% of cases were diagnosed in Stage 0 or I, but nearly 14% were stage unknown, likely due to inadequate or shave biopsies. Only 75% of Stage II patients and 14% of unknown stage patients had their lymph nodes evaluated. Less then half of those in Stage III (46%) or node-positive unknown stage (43%) received adjuvant therapy.
MMC has less early stage disease and was proactive with lymph node evaluation. Survival trends were similar to national trends.

Conclusions:
Educational efforts within the state of Maine should be directed towards biopsy technique and indication for nodal evaluation. A centralized IRB will enhance clinical trial opportunities.


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