scholarly journals Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: protocol for a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032969 ◽  
Author(s):  
Clare Amy Primiero ◽  
Aideen M McInerney-Leo ◽  
Brigid Betz-Stablein ◽  
David C Whiteman ◽  
Louisa Gordon ◽  
...  
Keyword(s):  
High Risk ◽  
Controlled Trial ◽  
Clinical Care ◽  
Melanoma Risk ◽  
Surveillance Programme ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
Total Body ◽  
Randomised Controlled ◽  
Digital Dermoscopy

IntroductionMelanoma is Australia’s fourth most common cancer. Early detection is fundamental in maximising health outcomes and minimising treatment costs. To date, population-based screening programmes have not been justified in health economic studies. However, a skin surveillance approach targeting high-risk individuals could improve the cost-benefit ratio.Methods and analysisThis paper describes a 2-year longitudinal randomised controlled trial (RCT) to compare routine clinical care (control) with an intensive skin surveillance programme (intervention) consisting of novel three-dimensional (3D) total-body photography (TBP), sequential digital dermoscopy and melanoma-risk stratification, in a high-risk melanoma cohort. Primary outcomes will evaluate clinical, economic and consumer impact of the intervention. Clinical outcomes will evaluate differences in the rate of lesion excisions/biopsies per person, benign to malignant ratio for excisions and thickness of melanomas diagnosed. A health economic analysis using government data repositories will capture healthcare utilisation and costs relating to skin surveillance. Consumer questionnaires will examine intervention acceptability, the psychological impact, and attitudes towards melanoma risk and sun protective behaviour. Secondary outcomes include the development of a holistic risk algorithm incorporating clinical, phenotypic and genetic factors to facilitate the identification of those most likely to benefit from this surveillance approach. Furthermore, the feasibility of integrating the intervention with teledermatology to enhance specialist care in remote locations will be evaluated. This will be the first RCT to compare a targeted surveillance programme utilising new 3D TBP technology against current routine clinical care for individuals at high risk of melanoma.Ethics and disseminationThis study has received Human Research Ethics Committee (HREC) approval from both Metro South Health HREC (HREC/17/QPAH/816) and The University of Queensland HREC (2018000074).Trial registration numberANZCTR12618000267257; Pre-results.

scholarly journals AB0903-HPR DURATION OF TELEPHONE CONSULTATIONS AMONGST RHEUMATOLOGY PRACTITIONERS IN A DISTRICT GENERAL HOSPITAL - ADAPTING TO REMOTE CONSULTATION IN A COVID-19 PANDEMIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1474.1-1474
Author(s):  
L. Parker ◽  
F. Coldstream
Keyword(s):  
General Hospital ◽  
Controlled Trial ◽  
Clinical Care ◽  
District General Hospital ◽  
British Society ◽  
Nice Guideline ◽  
Face To Face ◽  
Co Morbidity ◽  
Randomised Controlled ◽  
Remote Consultations

Background:The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease.Objectives:To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period.Methods:All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode.Results:Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 - 30 minutes, 37 (11%) lasted 31 - 45 minutes, and 6 (2%) lasted 46 - 60 minutes. The average duration was 22 minutes.Conclusion:Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully face-to-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.References:[1]Pinnock H, Bawden R, Proctor S, Wolfe S, Scullion J, Price D, Sheikh A. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ. 2003 Mar 1;326(7387):477-9. doi: 10.1136/bmj.326.7387.477. PMID: 12609944; PMCID: PMC150181.[2]National Institute for Health and Care Excellence (NICE) (2018) rheumatoid arthritis in adults: management (NICE Guideline NG100). Available at https://www.nice.org.uk/guidance/ng100 [Accessed 05 January 2021].Disclosure of Interests:None declared

scholarly journals Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20–22 February 2020

2021 ◽  
Vol 28 (3) ◽  
pp. 2040-2051
Author(s):  
Christina W. Lee ◽  
J. Gregory McKinnon ◽  
Noelle Davis
Keyword(s):  
High Risk ◽  
Brain Magnetic Resonance Imaging ◽  
Initial Therapy ◽  
Expert Opinions ◽  
High Risk Melanoma ◽  
Novel Approach ◽  
Positron Emission ◽  
Risk Melanoma ◽  
National Expert ◽  
Melanoma Surveillance

Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to “who, what, where, and when” HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees.

Duration of High-Dose Interferon Alfa-2b Regimen for Resected High-Risk Melanoma

2009 ◽  
Vol 27 (25) ◽  
pp. e82-e83 ◽  
Author(s):  
Sanjiv S. Agarwala ◽  
Robert J. Gray ◽  
Michael K.K. Wong
Keyword(s):  
High Risk ◽  
Interferon Alfa ◽  
High Dose ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
High Dose Interferon

The p.G23S CDKN2A founder mutation in high-risk melanoma families from Central Italy

2007 ◽  
Vol 17 (6) ◽  
pp. 387-392 ◽  
Author(s):  
Francesca Gensini ◽  
Roberta Sestini ◽  
Mauro Piazzini ◽  
Marina Vignoli ◽  
Alessandra Chiarugi ◽  
...  
Keyword(s):  
High Risk ◽  
Founder Mutation ◽  
Central Italy ◽  
High Risk Melanoma ◽  
Risk Melanoma

scholarly journals CN4 COST-EFFECTIVENESS (CE) ANALYSIS OF INTERFERON-ALPHA IN HIGH-RISK MELANOMA PATIENTS

2004 ◽  
Vol 7 (3) ◽  
pp. 221 ◽  
Author(s):  
M Ding ◽  
Y Xing ◽  
T Shih ◽  
D Cox ◽  
S Cantor ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Interferon Alpha ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
Melanoma Patients
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