Implementation of melanoma guidelines in the multidisciplinary setting: A qualitative analysis

Nicole M Mott; Zoey N Duncan; Cecilia M Pesavento; Andrew F Vastardis; Brooke C Bredbeck; Cameron A Harter; Lesly A Dossett; Kristy K Broman; Tasha M Hughes

doi:10.1016/j.amjsurg.2022.09.039

Implementation of melanoma guidelines in the multidisciplinary setting: A qualitative analysis

Am J Surg. 2023 Feb;225(2):335-340. doi: 10.1016/j.amjsurg.2022.09.039. Epub 2022 Sep 25.

Authors

Nicole M Mott¹, Zoey N Duncan², Cecilia M Pesavento³, Andrew F Vastardis³, Brooke C Bredbeck⁴, Cameron A Harter³, Lesly A Dossett⁴, Kristy K Broman⁵, Tasha M Hughes⁶

Affiliations

¹ University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Colorado Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA. Electronic address: nmmott@umich.edu.
² The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
³ University of Michigan Medical School, Ann Arbor, MI, USA.
⁴ University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
⁵ The University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA. Electronic address: tmhughes@med.umich.edu.

PMID: 36180302
DOI: 10.1016/j.amjsurg.2022.09.039

Abstract

Background: Data suggest variation in utilization of completion lymph node dissection (CLND) and adjuvant systemic therapy (AT) for sentinel lymph node-positive melanoma. We aimed to explore how clinicians consider multidisciplinary treatment options.

Methods: We conducted semi-structured interviews of surgical oncologists, medical oncologists, and otolaryngologists to produce a thematic analysis.

Results: Participants (n = 26) described melanoma care as inherently "multidisciplinary," noting the importance of conversations facilitated by shared clinic days or space. Despite believing that their practice mirrored other clinicians, participants revealed diverging perspectives on CLND and AT. Multidisciplinary care presented challenges for surveillance as surgeons expressed desire to retain ownership of patients but did not feel comfortable overseeing AT needs. Participants questioned the fidelity of nodal ultrasounds, noted redundancy in their roles, and described a "surveillance burden" for patients.

Conclusion: Opportunities exist to improve multidisciplinary melanoma care through broader consensus of how to translate emerging data into patient care and delineating surveillance roles.

Keywords: Adjuvant therapy; Completion lymph node dissection; Implementation; Melanoma; Multidisciplinary.

MeSH terms

Humans
Lymph Node Excision
Melanoma* / pathology
Melanoma* / surgery
Sentinel Lymph Node Biopsy
Sentinel Lymph Node* / pathology
Skin Neoplasms* / pathology
Skin Neoplasms* / surgery