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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 5 of 5 Research Studies DisplayedPagani K, Lukac D, Olbricht SM
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
The purpose of this study was to explore primary care and dermatology triaging and processing of urgent dermatology referrals. The researchers conducted chart reviews of all dermatology referrals designated by primary care as urgent for evaluation of a lesion concerning for skin cancer. Dermatology encounters for patients occurred on or before 30 days for 50.6% of referrals and on or after 31 days for 38.4% of referrals, with 10.9% never completed. The rate of non-English languages in the delayed group was 7.1% greater than in the timely group. The rate of all races excluding whites, non-Hispanic in the delayed appointment group (31 days or more) was 15.1% greater than in the timely appointment group (30 days or less). Overall, 15.8% of referrals yielded malignancy diagnoses, while 76.8% and 7.4% resulted in benign and pre-malignant diagnoses, respectively. The primary care team documented completed, incomplete, or pending referral status during their subsequent visits with the patients in only 37.5% of the referrals.
AHRQ-funded; HS027282.
Citation: Pagani K, Lukac D, Olbricht SM .
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
Arch Dermatol Res 2023 Jul; 315(5):1397-400. doi: 10.1007/s00403-022-02456-7..
Keywords: Cancer: Skin Cancer, Cancer, Primary Care, Skin Conditions, Access to Care
Herb JN, Ollila DW, Stitzenberg KB
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
This study looked at the utility of sentinel lymph node biopsy (SLNB) for non-ulcerated T1b melanoma. The aim of the study was to estimate SLNB use, positivity, prevalence, and procedural costs in patients with non-ulcerated T1b melanoma using a population-based registry. Patients with clinically node-negative, non-ulcerated T1b melanoma were identified in the SEER database from 2010 to 2016. Among 7245 included patients, 53% underwent SLNB of which 156 (4.1%) had a positive SLNB. Higher odds of positivity were associated with younger age, >1 mitosis per mm2, female sex, and truncal tumor location. Estimated SLNB costs to identify one patient with Stage II disease was $71,700. Out-of-pocket expenses for a Medicare patient was estimated to be $652 for a wide local excision (WLE) and SLNB and $79 for WLE alone.
AHRQ-funded; HS000032.
Citation: Herb JN, Ollila DW, Stitzenberg KB .
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
Ann Surg Oncol 2021 Jul;28(7):3470-78. doi: 10.1245/s10434-021-09998-6..
Keywords: Cancer: Skin Cancer, Cancer, Surgery, Healthcare Costs, Skin Conditions
Herb JN, Dunham LN, Ollila DW
Use of completion lymph node dissection for sentinel lymph node-positive melanoma.
This study examined the use and time trends of completion lymph node dissection (CLND) for sentinel lymph node-positive melanoma (SNPM). There has been found to be no benefit for CLND in SNPM patients. The National Cancer Database was used to find patients 18 years and older from 2012 to 2016 with SNPM. During that time period, 7,146 patients were identified with SNPM. From 2012 to 2014 the proportion of patients undergoing CLND was steady (61-63%) but decreased to 57% in 2015 and 50% in 2016. Use was less likely for women and increasing age. Higher use was more likely at high-volume centers, and associated with increased Breslow depth and ulceration.
Citation: Herb JN, Dunham LN, Ollila DW .
Use of completion lymph node dissection for sentinel lymph node-positive melanoma.
J Am Coll Surg 2020 Apr;230(4):515-24. doi: 10.1016/j.jamcollsurg.2019.12.010..
Keywords: Cancer: Skin Cancer, Cancer, Skin Conditions, Treatments
Montgomery KB, Holder AM, Burgan CM
Is it time for synoptic reporting in melanoma nodal surveillance ultrasonography?
Previous qualitative research has identified a potential gap between surgeons’ and radiologists’ awareness of Second Multicenter Selective Lymphadenectomy Trial (MSLT-II) criteria. The purpose of this study was to explore how these criteria have been adopted and reported outside of clinical trial settings or utilized by surgical teams when interpreting ultrasound results. The study found that of the 269 nodal ultrasounds performed in 78 patients, 81.0% reported normal findings versus 19% abnormal findings. Researchers indicated that only 15% of normal ultrasounds had one or more MSLT-II criteria reported versus 88.9% abnormal ultrasounds. While 37% of abnormal ultrasounds had only one MSLT-II criterion reported, 27.8% had two criteria and 24.1% had three criteria. Of the eight abnormal ultrasounds with biopsy recommendation, 75% had two or more MSLT-II criteria reported. Clinically actionable recommendations were provided in 94.9% of normal ultrasounds compared with 64.8% of abnormal ultrasounds.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Holder AM, Burgan CM .
Is it time for synoptic reporting in melanoma nodal surveillance ultrasonography?
Ann Surg Oncol 2023 Sep; 30(9):5327-28. doi: 10.1245/s10434-023-13749-0..
Keywords: Cancer: Skin Cancer, Cancer, Skin Conditions, Imaging
Banerjee M, Lao CD, Wancata LM
Implications of age and conditional survival estimates for patients with melanoma.
This study identified newly diagnosed cutaneous melanoma patients and estimated conditional 5-year survival. Over time, conditional survival estimates improved for older patients with localized and regional disease. Understanding the conditional 5-year disease-specific survival of melanoma based on age and stage can help patients and physicians, informing decision-making about treatment and surveillance.
AHRQ-funded; HS020937.
Citation: Banerjee M, Lao CD, Wancata LM .
Implications of age and conditional survival estimates for patients with melanoma.
Melanoma Res 2016 Feb;26(1):77-82. doi: 10.1097/cmr.0000000000000213.
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Keywords: Elderly, Cancer: Skin Cancer, Cancer, Mortality, Skin Conditions