{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:56:34Z","timestamp":1765886194009},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"3-4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Compared to their civilian counterparts, military personnel can have more exposure to sunlight and, as recent studies have shown, do have an increased incidence of melanoma. Given the inherent challenges service members may face in getting appropriate care whether because of operational tempo, deployments, and\/or austere locations, many are initially diagnosed by specialties other than dermatology. In this study, we sought to determine if patients within the military health system were receiving appropriate follow-up management after biopsies by non-dermatologists led to the diagnosis of melanoma by pathology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Using the Co-Path system, 1,000 patients were identified who had first time biopsies positive for melanoma. Of these, 73 were originally biopsied by non-dermatologists. Retrospective medical record review was performed to determine specialties of the non-dermatologists, staging of melanoma at diagnosis, referrals to specialists and dermatologists, and adherence to National Comprehensive Cancer Network guidelines. The study protocol was approved by the Walter Reed National Military Medical Center Institutional Review Board, protocol number WRNMMC-EDO-2017-0030, in compliance with all applicable federal regulations governing the protection of human subject research.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Family medicine physicians made up the majority of non-dermatologists involved in performing biopsies that led to the diagnosis of melanoma in this study. Most patients were Stage I (pT1a), and the average time from initial biopsy to further wide excision biopsy was 18\u00a0days. Sixty-seven of the 73 patients biopsied by non-dermatologists received referrals to dermatologists, and 55 of the 67 patients followed through with being seen. Follow-up full body skin exams were performed on 55 of the 73 patients, with dermatologists conducting the majority of them. National Comprehensive Cancer Network guidelines were followed in 45 of the 73 patients, with an additional 24 patients having insufficient evidence to determine if guidelines were adhered to.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our study demonstrated that a number of different specialties outside of dermatology are involved in performing biopsies on patients in which melanoma is a concern. Although the results show that the majority of patients biopsied by non-dermatologists received appropriate follow-up care, there is still room to improve to ensure that all melanoma patients receive referrals to and are seen by dermatologists after a diagnosis of melanoma.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usz244","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T19:11:09Z","timestamp":1572462669000},"page":"506-511","source":"Crossref","is-referenced-by-count":2,"title":["Management of Melanoma Patients by Non-Dermatologists in the Military Health System: A Retrospective Observational Study"],"prefix":"10.1093","volume":"185","author":[{"given":"Kenneth J","family":"Helmandollar","sequence":"first","affiliation":[{"name":"Washington Navy Yard Branch Health Clinic, Building 175, 915 N Street S.E., Washington, DC 20374-5022"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan C","family":"Lorei","sequence":"first","affiliation":[{"name":"Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barak C","family":"Clement","sequence":"first","affiliation":[{"name":"School of infantry (West), H&S Battalion, Section: Medical, Box 555061, Camp Pendleton, CA 92055"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara R","family":"Hoverson","sequence":"first","affiliation":[{"name":"Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas F","family":"Logemann","sequence":"first","affiliation":[{"name":"Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,28]]},"reference":[{"key":"2020040711152509600_ref1","volume-title":"Cancer Facts and Figures 2019","author":"American Cancer Society","year":"2019"},{"key":"2020040711152509600_ref2","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.jaad.2017.11.062","article-title":"Skin cancer in the military: a systematic review of melanoma and non-melanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel","volume":"78","author":"Riemenschneider","year":"2018","journal-title":"J Am Acad Dermatol"},{"issue":"613","key":"2020040711152509600_ref3","doi-asserted-by":"crossref","first-page":"e563","DOI":"10.3399\/bjgp13X670697","article-title":"Mortality and morbidity after initial diagnostic excision biopsy of cutaneous melanoma in primary versus secondary care","volume":"63","author":"Murchie","year":"2013","journal-title":"Br J Gen Pract"},{"issue":"4","key":"2020040711152509600_ref4","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/13814788.2016.1232386","article-title":"Comparing initial diagnostic excision biopsy of cutaneous malignant melanoma in primary versus secondary care: a study of Irish National data","volume":"22","author":"Doherty","year":"2016","journal-title":"Eur J Gen Pract"},{"key":"2020040711152509600_ref5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.ejca.2017.09.034","article-title":"Is initial excision of cutaneous melanoma by general practitioners (GPs) dangerous? 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