The surgical treatment of non-metastatic melanoma in a Clinical National Melanoma Registry Study Group (CNMR): a retrospective cohort quality improvement study to reduce the morbidity rates
Antonella Vecchiato,
Simone Mocellin,
Paolo Del Fiore,
Giulio Tosti,
Paolo A. Ascierto,
Maria Teresa Corradin,
Vincenzo De Giorgi,
Giuseppe Giudice,
Paola Queirolo,
Caterina Ferreli,
Marcella Occelli,
Monica Giordano,
Giusto Trevisan,
Luigi Mascheroni,
Alessandro Testori,
Romina Spina,
Alessandra Buja,
Francesco Cavallin,
Corrado Caracò,
Antonio Sommariva,
Carlo Riccardo Rossi,
on behalf of the Clinical National Melanoma Registry Study Group at the Italian Melanoma Intergroup (IMI)
Affiliations
Antonella Vecchiato
Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS
Simone Mocellin
Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS
Paolo Del Fiore
Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS
Giulio Tosti
Division of Melanoma, Sarcoma and Rare Tumors, IRCCS, European Institute of Oncology
Paolo A. Ascierto
Department of Melanoma and Cancer Immunotherapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale
Maria Teresa Corradin
Department of Dermatology, Santa Maria degli Angeli Hospital
Vincenzo De Giorgi
Section of Dermatology, Department of Health Sciences, University of Florence
Giuseppe Giudice
Division of Plastic and Reconstructive Surgery and Burn Unit, University of Bari
Paola Queirolo
Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS
Caterina Ferreli
Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari
Marcella Occelli
Medical Oncology Unit, Santa Croce and Carle Teaching Hospital
Monica Giordano
Pathology, ASST-Lariana, Ospedale Sant’Anna
Giusto Trevisan
DSM-Department of Medical Sciences, University of Trieste
Luigi Mascheroni
Unit of General Surgery, San Pio X Hospital
Alessandro Testori
Department of Dermatology, Fondazione IRCCS Policlinico San Matteo
Romina Spina
Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS
Alessandra Buja
Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padova
Francesco Cavallin
Independent Statistician
Corrado Caracò
National Cancer Institute Fondazione G. Pascale, SC Chirurgia Melanoma e dei Tumori Cutanei
Antonio Sommariva
Unit of Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS
Carlo Riccardo Rossi
Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS
on behalf of the Clinical National Melanoma Registry Study Group at the Italian Melanoma Intergroup (IMI)
Abstract Background Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. Methods Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. Results Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. Conclusions Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management.
