P062 A multicentre retrospective observational study reviewing the management of severely dysplastic naevi
Notice bibliographique
Résumé
Abstract The aim of this study was to evaluate management of severely dysplastic naevi (SDN) across two NHS trusts over 5 years. A natural language search was performed on the local histopathology system (Copath) to identify all SDN excised between 1 January 2018 and 1 January 2023. Duplicates, cases from external trusts, and histology reports mentioning ‘melanoma in situ’ (MIS) were excluded. Many cases had a spectrum of dysplastic changes mentioned in the report; in such cases the most severe diagnosis was used. Electronic medical records were reviewed to ascertain the surgical excision margin, histological margin, multidisciplinary team (MDT) discussion, management and duration of follow-up. In total, 136 cases were identified, of which 82 met the inclusion criteria. Trust A had 43 included cases and Trust B had 39 included cases. Overall, 58% (n = 25) of Trust A and 97% (n = 38) of Trust B cases were excised with a 2-mm surgical margin, while 81% (n = 35) of Trust A cases and 85% (n = 33) of Trust B cases were excised with at least a 1-mm histological margin. In total, 44% (n = 19) of Trust A and 51% (n = 20) of Trust B cases were discussed at skin cancer MDT. The diagnoses of two cases at Trust A were upgraded to MIS, and one case at Trust B was upgraded to a pT1a melanoma after MDT review. Overall, 74% (n = 32) of cases at Trust A were offered wide local excision (WLE); of these, 78% (n = 25) were to achieve 5-mm clearance. In total, 18% (n = 7) of cases at Trust B were offered WLE; of these, 29% (n = 2) were to achieve 5-mm clearance. Monitoring was recommended in 2% (n = 1) of Trust A cases and 26% (n = 10) of Trust B cases. Our results demonstrate that management of SDN can differ substantially between trusts. Trust A managed the majority (58%) of cases as MIS, whereas Trust B took a more conservative approach. There was no significant difference in outcome. There are currently no consensus guidelines on the management of SDN in the UK or internationally. Surveys from Australia, Canada, the USA and the UK have shown variation in clinical practice. Review of the current literature supports the re-excision of incompletely excised SDN and monitoring (as opposed to re-excision) of completely excised SDN, as the risk of progression to melanoma appears low. Our results highlight the need for consensus guidelines to manage these cases to provide optimal and consistent patient care, as well as minimizing unnecessary and potentially disfiguring surgery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».