Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand
Cancer Council Australia, Australian Cancer Network, Ministry of Health, New Zealand
These guidelines were developed for use in 2 countries with a very high incidence of melanoma1. From 1998 to 2002, the age-standardized incidence rate of melanoma in Australia and New Zealand ranged from 21.7 to 55.8 per 100,000 population, depending on sex and region2. Comparatively, the age-standardized incidence of skin melanoma in Canada was 15.7 per 100,000 in 20073.Most melanomas are the result of exposure to ultraviolet radiation from the sun4, and survival has been associated with depth of invasion, which suggests a role for early detection1. Therefore, this guideline focuses on prevention, screening, and identification and management of individuals at high risk of melanoma.
The following sections of this guideline are applicable to the CTFPHC mandate of prevention in primary care:
The target population for this guideline is not clearly stated; however, on the basis of the recommendations, it can be inferred that it applies to people of all ages and all ethnic backgrounds.
The following databases were searched from mid-2006 to early 2007: MEDLINE, Embase, PubMed, CINAHL, Cochrane Library, AUSThealth, Clinical Evidence, and PsycINFO. Reference lists of relevant articles were hand searched. The specific research questions are unknown.
GRADING SYSTEM Each recommendation was assigned a grade of A to D, based on features of the body of evidence, including volume, consistency, generalizability, applicability and clinical impact1. “Good practice points” refer to statements made by the developer that could not be graded.
METHODOLOGICAL QUALITY The CTFPHC assessed the methodological quality of the guideline using the Appraisal of Guidelines Research & Evaluation (AGREE II) criteria (Table 1).This guideline scored above 60% on the domains of Scope and Purpose, Rigour of Development, and Editorial Independence; therefore, the CTFPHC has classified it as a high-quality guideline. Concordance among reviewers, as measured through standard deviation of AGREE II scores, was high (SD < 1.5) for all domains except Editorial Independence.
|AGREE II domain||Domain score||Standard deviation|
|Scope and purpose||83%||1.4|
|Rigour of development||70%||1.3|
|Clarity of development||86%||0.7|
The scope and purpose of this guideline are clearly described, with good separation of screening from diagnosis and case-finding. The recommendations are presented clearly, with links to the supporting evidence. Further, the guideline development group included individuals from all relevant disciplines, as well as a consumer representative, and the views and preferences of patients were sought through public review.
However, the rigour of development scored relatively low, primarily because methodological details (research questions, inclusion and exclusion criteria) were only available upon request (information not received), making it difficult to determine whether the included evidence is appropriate. There is also a lack of discussion about facilitators and barriers to the application of these recommendations, which would have been helpful for family physicians. Although these recommendations are based on evidence obtained in early 2007, the guideline states that updates will be posted online if needed6. Methods are provided for addressing conflicts of interest, but the CTFPHC did not identify any evidence of such conflicts.
Overall, this guideline provides clear and concise recommendations for prevention, screening and identification of individuals at high risk of melanoma. Although the incidence of melanoma is lower in Canada than in Australia and New Zealand, the recommendations seem sensible and applicable for use in Canadian practice.
The full guideline can be found at cancer.org.au.
Population screening for melanoma
Identification and management of high-risk individuals