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693 The Need for Increased Melanoma Awareness among Non-dermatology Secondary Care Colleagues Catherine QUINLAN 1 , Stephen MCCRACKEN 2 , Emma TIERNEY 1 , Cynthia HEFFRON 2,3 , James FITZGIBBON 2,3 , Conleth MURPHY 2,4 , John F. BOURKE 1,2 and Michelle MURPHY 1,2 Department of Dermatology, South Infirmary Victoria University Hospital, Old Blackrock Road, 2 School of Medicine, University College, Department of Histopathology, Cork University Hospital, and 4 Department of Medical Oncology, Bon Secours Hospital, Cork, Ireland. E-mail: [email protected] 1 3 Accepted Mar 21, 2019; E-published Mar 21, 2019 The incidence of melanoma is increasing and is projected to continue to do so (1). In Ireland, 20 people per 100,000 of the population develop invasive melanoma every year and 159 die from it (2). Despite improvements in early detection (3), the num- ber of deep poor prognosis melanomas remains high (4). Older age, male sex (5), living alone and lower education level (6), have been identified as factors associated with thick melanomas. There has been much focus on the role of general practitioners in melanoma screening strategies. However, the role of non-dermatology hospital services in detecting melanoma has been poorly explored. The aim of this project was to determine if an opportunity exists for detection of melanoma in secondary care facilities. MATERIAL AND METHODS Ethical approval was obtained from the Cork Research Ethics Committee. A retrospective case review was conducted at 5 hospitals across the region. The pathology database at Cork University Hospital (CUH), which processes histology samples from all 5 hospitals, was searched. The inclusion criteria were patients with a Cork/ Kerry address, diagnosed with primary cutaneous melanoma ≥ 1 mm Breslow depth, between January 2013 and December 2014. Each clinical site was visited and hospital utilization data for each patient at each of the 5 clinical sites was collected. There were 106 patients included in the study; 51 men (48%) and 55 women (52%). The mean age was 63 years at time of diagnosis. RESULS The median Breslow depth was 2.3 mm with a range from 1.0 mm to 41 mm. Twenty-three (22%) were > 5 mm Breslow depth at time of diagnosis. Sixty-seven percent (n = 71) of patients were seen in secondary care in the 5 years prior to their diagnosis of melanoma. There were a total of 901 healthcare interactions. The majority of these interactions were in the outpatient setting (57.5%). However, almost one third (31%) had an inpatient admis- sion in the 5 years prior to diagnosis with a mean length of stay of 6 days. Forty-five patients (42.5%) were seen in secondary care in the year prior to diagnosis. Results are illustrated in Fig. 1. There were a total of 214 healthcare interac- tions. Thirty-five percent (n = 37) were seen in outpatient clinics and 10.4% (n = 11) had an inpatient admission. The median Breslow depth in this group was 2.5 mm. SHORT COMMUNICATION 40 Inpatient admissions 35 ED visits Day Case admissions 30 Outpatient visits 25 20 15 11 patients 11 patients 13 patients 10 5 0 1 year prior Fig. 1. Secondary care interactions in the year prior to melanoma diagnosis. (ED=Emergency Department). Forty percent (n = 18) of these patients had melanomas located on the head and neck. Head and neck was the most common anatomical location (n =32) followed by lower limb (n =30), upper limb (n =22) and trunk (n =22). Of the 32 patients with a head and neck melanoma, 18 (56%) had been seen in secondary care in the year prior to their diagnosis. In terms of histological subtype, the majority were superficial spreading type (n =48) followed by nodular (n =30), lentigo maligna (n =18), other (n =6) and acral lentiginous (n =4). The specialties with the most patient interactions in the year prior to diagnosis were ophthalmology, ortho- paedics, and emergency medicine. DISCUSSION This study has identified that patients with thick me- lanomas are being seen in hospital in the year prior to their diagnosis. Research on the use of health services in the year prior to diagnosis of melanoma have found similar results (7, 8), but these studies did not isolate for interactions in secondary care. Outpatient visits contri- buted to the majority of healthcare interactions in our study. While there may be limited opportunity for full skin examination in an outpatient setting, studies have shown that even opportunistic partial skin examinations This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. 37 patients doi: 10.2340/00015555-3180 Acta Derm Venereol 2019; 99: 693–694