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Objective: We aimed to review the proportion of influenza-like illness (ILI) that could be attributed to influenza infection over five consecutive influenza seasons in Victoria, to compare ILI activity with hospital admissions for influenza, and to develop thresholds that would indicate when ILI activity may coincide with increases in influenza hospitalisations. Methods: Combined nose/throat swabs from patients with ILI selected from sentinel general practices were tested for influenza and other respiratory viruses at the Victorian Infectious Diseases Reference Laboratory. The proportion of ILI attributed to laboratory-confirmed influenza was evaluated for five consecutive surveillance seasons, from 1998 to 2002. The seasonal patterns of ILI and laboratory-confirmed influenza were compared for 2000-02. ILI surveillance from sentinel general practices between 1997 and 2000 was compared with hospital admissions for influenza extracted from the Victorian Admitted Episodes Dataset between 1994 and 2000. Results: Approximately 41% of all ILI cases from sentinel general practices were confirmed to have an influenza infection between 1998 and 2002. The seasonal pattern of ILI and confirmed influenza among patients selected from sentinel general practices was very similar over three influenza seasons. The trends for ILI rates in sentinel general practices appeared to correlate remarkably well with those of hospital admissions for influenza. Thresholds for ILI were defined as: baseline 1.5-3.5; and epidemic activity above 3.5. Conclusion: ILI rates from sentinel general practices correspond with hospital admissions coded as influenza and allow the use of threshold levels to describe seasonal influenza activity.

Background/Objectives: In melanoma management, sentinel lymph node biopsy (SLNB) is used to stage patients and to indicate prognosis. More recently, it has been used to select patients for adjuvant therapy. This study aimed to report knowledge of and attitudes towards SLNB for patients with melanoma among Australian dermatologists. Methods: Mixed methods study using cross‐sectional questionnaires (n = 88) and semi‐structured interviews (n = 13), May–September 2019. Results: Of the dermatologists surveyed, 56% thought SLNB had an important role in melanoma management, 26% were unsure and 18% thought SLNB unimportant. Of the 92% who would discuss SLNB with their patients, the main stated value of SLNB was for assessing eligibility for adjuvant therapies (79%); only 60% indicated SLNB was of value for providing prognostic information, and just over half (53%) thought it could improve staging. Interview data indicated that attitudes towards SLNB are shifting among dermatologists, driven by data from landmark clinical trials and the influence of professional networks. Accordingly, interviewees adopted one of three positions in relation to SLNB: (a) believed in utility of SLNB and adhered to the guidelines; (b) were unconvinced about utility of SLNB but adhered to the guidelines; and (c) were unconvinced about utility of SLNB and did not adhere to the guidelines. Conclusion: Although most of the dermatologists surveyed were familiar with and follow the SLNB recommendations, some disagreement with and distrust of the recommendations was evident. Greater acceptance of the SLNB recommendations appeared to be driven by the improved outcomes demonstrated in stage III patients receiving adjuvant systemic therapy. [ABSTRACT FROM AUTHOR]

Background: In Australia, melanoma is managed in primary and secondary care settings. An individual concerned about a suspicious lesion typically presents first to their GP. Aim: To identify factors influencing GPs' decisions to diagnose, treat, or refer patients with suspected melanoma. Design & setting: Semi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia. Method: The semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data. Results: Considerable variation existed in GPs' self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs' decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP's clinical interests, the clinical features (for example, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management. Conclusion: GP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate. [ABSTRACT FROM AUTHOR]

Between 2010-11 and 2016-17, shave biopsies increased from 16.0% to 20.4% of all biopsies (adjusted risk ratio 1.77 compared with all other types, 95% confidence interval 1.43-2.20; I P i < 0.001), whereas there was no statistically significant change for the other biopsy categories. Https://doi.org/10.1093/bjd/ljac111 Dear Editor, Owing to the large number of skin cancers being managed in Australian general practice,[1] it is important to document the trends and preferences of general practitioners' (GPs) diagnostic approach to suspicious skin lesions, to inform guidelines for diagnosis and ensure safe and cost-effective treatment in general practice. After categorization by keyword based on the reason-for-encounter field, we found that punch biopsy (42.9%) was the most common biopsy type, followed by shave biopsy (19.0%), excision (13.2%) and curettage or incision (0.4%). [Extracted from the article]

Background/Objectives: There are limited population‐based data documenting the incidence and management of lentigo maligna (LM) and invasive lentigo maligna melanoma (LMM). We report the data on occurrence and management of LM and LMM in an Australian population. Methods: Prospective collection of incidence and clinician‐reported management of melanoma in situ (MIS; n = 450, capped) and localised invasive melanoma (n = 3251) notified to the New South Wales Cancer Registry over 12‐months in 2006–2007. Results: The estimated annual incidence of all MIS was 27.0 per 100 000 (LM 12.2, non‐LM MIS 5.9 and unclassified MIS 9.0). Patients with LM or LMM were on average approximately 10 years older than those with other melanoma subtypes (P < 0.001). The head and neck was the location of 59% of LM, 44% of LMM and <20% of other melanoma subtypes (P < 0.001). The majority of LM and LMM were treated only by specialists. Diagnostic partial biopsies were more frequent for LM and LMM than for other melanoma subtypes, and primary care physicians were more likely than specialists to do a punch partial biopsy than a shave biopsy. The reported median definitive excision margin for LM was 5.0 mm compared with 7.2 mm for non‐LM MIS (P = 0.001). Conclusions: In this Australian population, LM was twice as frequent as other types of MIS. Improved strategies for diagnosis and management are required. [ABSTRACT FROM AUTHOR]