Avaliação da abordagem inicial e das características epidemiológicas, clínicas e histológicas do melanoma cutâneo em Fortaleza

Abstract

Cutaneous melanoma is the most significant form of skin cancer due to its rising incidence and substantial mortality. Although well-defined protocols exist for the management of suspicious and diagnosed lesions, numerous studies have documented errors in clinical handling. Data on management practices and histopathological profiles in Brazil remain scarce. This study aimed to evaluate the initial management practices of cutaneous melanoma by dermatologists and other physicians, as well as the severity of the disease among patients from different healthcare settings in Fortaleza and Ceará macroregion, Brazil. This was a retrospective study analyzing data from histopathological reports of 1,483 patients diagnosed with primary cutaneous melanoma, treated at Walter Cantídio University Hospital (HUWC) of the Federal University of Ceará (UFC), Hospital Haroldo Juaçaba from the Cancer Institute of Ceará (ICC), and ARGOS pathology laboratory. Regarding healthcare origin, 52% of patients were from the public health system, 36% from health insurance plans, 9.9% out-of-pocket, and 2.5% from low-cost clinics. There was a predominance of female (55%) with a mean age of 58 ± 16 years. The trunk was the most frequent site (40%), followed by the lower limbs (25%). The most frequent histological subtype was superficial spreading melanoma (67%), with great variability of other subtypes among the three centers. In situ lesions accounted for approximately 25% of cases. Regarding surgical technique (n = 1,261), excisional biopsy was the most common procedure (87%), with nearly half of these cases originating from the public system (49%). Primary melanomas initially managed by dermatologists were more likely to be in situ (41%) and had a lower Breslow thickness (1.0 mm) compared to those managed by non-dermatologists (19% and 3.6 mm, respectively). Patients from supplementary health system had a higher frequency of in situ lesions (38%) and lower Breslow thickness (1.2 mm) than those from public system (15% and 4.4 mm, respectively). The associations remained statistically significant after adjustment for relevant covariates defined a priori. Patients from the private healthcare sector were 2.6 times more likely to be diagnosed with melanoma in situ compared to those from the public sector (OR = 2.6; 95% CI = 1.97–3.45; p < 0.001). Furthermore, cases initially evaluated by dermatologists had twice the odds of being diagnosed with melanoma in situ compared to those assessed by other specialists (OR = 1.99; 95% CI = 1.50–2.63; p < 0.001). There was a trend toward decreasing Breslow thickness over the study period. Evaluating differences in initial management techniques among specialists who perform initial approach of cutaneous melanoma, along with comparing clinical and prognostic characteristics of melanoma between patients from public and private scenarios, is important for better resources distribution and guidance of prevention, training and awareness efforts.