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Background <p>Many existing best practice guidelines suggest that preoperative diagnostic imaging for patients who have early-stage melanoma without clinically palpable lymph nodes may not be warranted. A community of practice (CoP) for Eastern Ontario, Canada set guidelines supporting the restricted use of preoperative diagnostic imaging in 2017. This study aimed to assess whether the proportion of patients with ≤T3b melanoma receiving guideline-discordant preoperative imaging decreased after the implementation and dissemination of the CoP guidelines.</p> Methods <p>Retrospectively collected data of patients with biopsy-proven primary melanoma who underwent wide local excision with or without sentinel lymph node biopsy surgery were included for analysis. Patients with biopsy dates before and after 24 May 2018 were grouped into the pre- and post-guideline cohorts, respectively. Frequency and type of preoperative imaging were collected and analyzed. Patient baseline demographics and tumor histologic characteristics were collected for multivariate analysis.</p> Results <p>The study included 628 patients (332 pre-guideline and 296 post-guideline patients). The patients in the post-guideline cohort had significantly lower rates of preoperative imaging than the pre-guideline cohort (<i>p</i> &lt; 0.001). In multivariable analysis, guideline dissemination was associated with lower odds of receiving preoperative imaging (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.12–0.38; <i>p</i> &lt; 0.001], whereas Breslow thickness was associated with receiving preoperative imaging (OR 1.83; 95% CI 1.43–2.35; <i>p</i> &lt; 0.001).</p> Conclusion <p>This report describes a reduction in guideline-discordant preoperative imaging after CoP guideline dissemination. The findings support the importance of quality improvement initiatives such as a CoP to advance melanoma care.</p>

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The Impact of a Regional Community of Practice to Improve Quality of Melanoma Care: Setting Guidelines for Preoperative Diagnostic Imaging in Early-Stage Melanoma

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Katherine Aw,
  • Rebecca Lau,
  • Boaz Wong,
  • Karine Riad,
  • Alex Lee,
  • Heidi Li,
  • Elysia Grose,
  • Olivier Brandts-Longtin,
  • Ahmad Abed,
  • James Stevenson,
  • Rahat Sheikh,
  • Richard Chen,
  • Clara Goulet,
  • Stephanie Johnson-Obaseki,
  • Carolyn Nessim

摘要

Background

Many existing best practice guidelines suggest that preoperative diagnostic imaging for patients who have early-stage melanoma without clinically palpable lymph nodes may not be warranted. A community of practice (CoP) for Eastern Ontario, Canada set guidelines supporting the restricted use of preoperative diagnostic imaging in 2017. This study aimed to assess whether the proportion of patients with ≤T3b melanoma receiving guideline-discordant preoperative imaging decreased after the implementation and dissemination of the CoP guidelines.

Methods

Retrospectively collected data of patients with biopsy-proven primary melanoma who underwent wide local excision with or without sentinel lymph node biopsy surgery were included for analysis. Patients with biopsy dates before and after 24 May 2018 were grouped into the pre- and post-guideline cohorts, respectively. Frequency and type of preoperative imaging were collected and analyzed. Patient baseline demographics and tumor histologic characteristics were collected for multivariate analysis.

Results

The study included 628 patients (332 pre-guideline and 296 post-guideline patients). The patients in the post-guideline cohort had significantly lower rates of preoperative imaging than the pre-guideline cohort (p < 0.001). In multivariable analysis, guideline dissemination was associated with lower odds of receiving preoperative imaging (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.12–0.38; p < 0.001], whereas Breslow thickness was associated with receiving preoperative imaging (OR 1.83; 95% CI 1.43–2.35; p < 0.001).

Conclusion

This report describes a reduction in guideline-discordant preoperative imaging after CoP guideline dissemination. The findings support the importance of quality improvement initiatives such as a CoP to advance melanoma care.