WASHINGTON — Military personnel often have more exposure to sunlight, compared to their civilian counterparts, and that can increase their risk of melanoma.
A study in Military Medicine discussed how operational challenges, such as deployment or austere locations —can make it challenging for servicemembers to get appropriate care.1
Washington Navy Yard Branch Health Clinic-led researchers pointed out that many are initially diagnosed by specialties other than dermatology.
“In this study, we sought to determine if patients within the military health system were receiving appropriate follow-up management after biopsies by non-dermatologists led to the diagnosis of melanoma by pathology,” the authors explained.
The study team used the Co-Path system to identify 1,000 patients who had first-time biopsies positive for melanoma. With 73 of those originally biopsied by nondermatologists, researchers performed retrospective medical record review to determine specialties of the nondermatologists, staging of melanoma at diagnosis, referrals to specialists and dermatologists and adherence to National Comprehensive Cancer Network guidelines.
The review determined that, in the study, family medicine physicians made up the majority of nondermatologists involved in performing biopsies that led to the diagnosis of melanoma. Most patients were Stage I (pT1a), and the average time from initial biopsy to further wide excision biopsy was 18 days.
The authors noted that 67 of the 73 patients biopsied by nondermatologists received referrals to dermatologists, and 55 of the 67 patients followed through with being seen.
In addition, follow-up full body skin exams were performed on 55 of the 73 patients, with dermatologists conducting the majority of them. National Comprehensive Cancer Network guidelines were followed in 45 of the 73 patients, with an additional 24 patients having insufficient evidence to determine guideline adherence, the study added.
“Our study demonstrated that a number of different specialties outside of dermatology are involved in performing biopsies on patients in which melanoma is a concern,” the authors concluded. “Although the results show that the majority of patients biopsied by non-dermatologists received appropriate follow-up care, there is still room to improve to ensure that all melanoma patients receive referrals to and are seen by dermatologists after a diagnosis of melanoma.”
- Helmandollar KJ, Lorei NC, Clement BC, Hoverson KR, Logemann NF. Management of Melanoma Patients by Non-Dermatologists in the Military Health System: A Retrospective Observational Study. Mil Med. 2020;185(3-4):506-511. doi:10.1093/milmed/usz244