New Zealand has the highest incidence of melanoma in the world. It is the fourth most common cancer and the sixth most common cause of cancer death. The Ministry of Health and regional cancer networks have proposed draft standards of service provision for melanoma patients in New Zealand.
We reviewed all patients with melanoma at Hutt Valley DHB over a twelve-month period from January – December 2015. We analysed our adherence to standards for staging, diagnosis, investigation, communication and referral, treatment and timely access to services.
Results: 78% of primary melanomas were excised with the recommended 2mm margins. 90% of HVDHB melanoma laboratory reports had a synopsis and AJCC stage documented while external laboratories had 25% AJCC diagnoses and 83% synoptic reports. 55% of all primary melanomas were reported within 5 working days with a mean diagnosis time of 11 days. 85% of all stage I and II melanoma patients had no further investigations 68% of patients with Stage IIIA and IIIB disease had CT PET.
For patients referred with a melanoma without a confirmed diagnosis, mean waiting time for specialist review was 35 days with 77% waiting longer than 14 days. Mean time to excision was 23 days with 62% waiting longer than 14 days. 68% waited for more than 62 days from referral to definitive treatment. For those with confirmed melanoma, mean time to specialist assessment was 18 days with 55% waiting more than 14 days with 9% waiting more than 62 days from referral to treatment. 16% of referrals met the electronic referral criteria. 56% of those with Stage IB or greater had a sentinel node biopsy. 95% had the appropriate wide excision margins.
Hutt Valley DHB meets the recommended criteria for Laboratory reporting, investigations and treatment but does not meet those for timely access to service.