26th July 2019, Volume 132 Number 1499

Joseph Winstanley, Emma Cervenak, Christopher Harmston

New Zealand has the highest age-standardised incidence of melanoma in the world,1 with 2,567 new cases diagnosed in 2016.2 The treatment of melanoma also consumes significant healthcare resources, with the…

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Patients with melanoma skin cancer which has spread to their lymph glands are normally advised to have a further operation to remove these diseased glands. In the future, this will change because the second operation doesn’t make you live any longer. Instead, health boards will need to follow these patients with regular scans and clinic visits. Here we have calculated the financial cost of this change. It looks to be affordable for the average provincial health board in New Zealand.



Two randomised trials have shown that immediate completion lymphadenectomy for sentinel node positive melanoma provides no long-term survival benefit; compared with a follow up regime of intensive nodal surveillance. The aim of this study was to assess the cost and resource implications of introducing this regime for patients with sentinel node positive melanoma in a provincial New Zealand hospital.


Patients with cutaneous melanoma presenting to Northland District Health Board between 1 January 2012 and 31 December 2014 were identified. The financial and resource burden of standard treatment was assessed, including operative, outpatient and imaging interventions. Financial and resource costs of intensive nodal observation for a theoretically equivalent cohort were calculated.


The cost of standard treatment was $7,147 per patient and the theoretical cost of nodal observation was $5,300 per patient. Standard treatment required more operating theatre time and inpatient treatment. Nodal observation required more outpatient appointments and imaging.


The cost of nodal observation was lower than standard treatment than in our study. There is a shift in resource requirements from operating theatre and inpatient care to outpatient appointment and imaging. The overall resource impact is low and introduction of nodal observation appears achievable.

Author Information

Joseph Winstanley, Department of General Surgery, Whangarei Base Hospital, Whangarei;
Emma Cervenak, Department of General Surgery, Whangarei Base Hospital, Whangarei;
Christopher Harmston, Department of General Surgery, Whangarei Base Hospital, Whangarei.


Dr Joseph Winstanley, Department of General Surgery, Whangarei Base Hospital, Maunu Road, Private Bag 9742, Whangarei 0148.

Correspondence Email


Competing Interests



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