![]() ![]() ![]() Postcodes were classified using the Accessibility Remoteness Index of Australia (ARIA) 13 and Socio-Economic Indexes for Areas (SEIFA) 14 classifications. The questionnaire data were managed using REDCap. The questionnaire was completed on paper or electronically and consisted of 24 items covering demographic characteristics, knowledge of melanoma guidelines, clinical management of melanoma, referral patterns, and attitudes to SLNB and shared care. Questionnaire and interview guide developmentĪ cross-sectional questionnaire and semi-structured interview guide (Supplementary file available online only) were developed from a literature review and discussion with a multidisciplinary team of melanoma clinicians and researchers. Of these, 23 also completed an interview and were reimbursed $100 for their time. Overall, 231 GPs completed a questionnaire. GPs were eligible to participate in the study if they had practised in Australia in the previous year. Recruitment of GPs was conducted at two Australian GP meetings: the Royal Australian College of General Practitioners (RACGP) annual conference in Queensland in October 2018, and a GP skin cancer–focused continuing medical education workshop in Sydney in December 2018 participants were also recruited through other GP professional communications. Quantitative and qualitative data were collected in the form of questionnaires and interviews. The aim of this study was to examine the knowledge and attitudes of GPs regarding the role of SLNB in the management of patients with invasive primary melanomas, to assist development of and adherence to guidelines. 10,11 Potential reasons for low uptake of SLNB include confusion about the evidence, lack of awareness of the guidelines, and individual preferences of GPs and patients. 7 There have been conflicting interpretations of the results from MSLT-I and other studies examining the benefits of SLNB in relation to the therapeutic value 8,9 and survival benefit of SLNB. 6 The Multicenter Selective Lymphadenectomy Trial (MSLT-I) showed improved disease-free survival but not overall melanoma-specific survival following SLNB. ![]() Data from the NSW Melanoma Patterns of Care study indicated that SLNB was undertaken for 45% of patients diagnosed with a melanoma >0.8 mm Breslow thickness who were potentially eligible for SLNB. 5 Historically, adherence to SLNB guidelines has not been optimal, allowing for patients who may refuse or not be suitable for SLNB. 5 SLNB should be performed at the time of the primary tumour wide excision. 1 The NSW Melanoma Patterns of Care study, 2 a population-based survey of in situ and invasive melanoma management in NSW in 2006–07, found the initial melanoma diagnosis was managed in general practice for 36% of patients, in skin cancer clinics (usually staffed by GPs) for 17%, in dermatology practices for 26%, by surgeons for 13% and by others for 1 mm in thickness and for patients with melanoma >0.8 mm in thickness with other high-risk pathological features. Some GPs with a special interest in skin cancer also perform wide excisions and flap repairs. A GP is therefore the person who will most often make a preliminary diagnosis, take the first biopsy and, following pathological confirmation of melanoma, decide on the need for referral for specialist care. In Australia, general practitioners (GPs) are the first point of contact for the majority of patients who develop melanoma. ![]()
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