L'augmentation de l'incidence du cancer du sein et son taux élevé de mortalité ont justifié la mise en place d'un dépistage mammographique. Dans le Doubs, département français de 500 000 habitants, le dépistage individuel a été généralisé dans les années 1990, il a été suivi par la mise en place du programme de dépistage organisé en 2003.

Background. - In 2005, following the first cancer plan of the national health authorities, a general cancer registry was established in northern France, in a territory designated as a "zone in proximity to the city of Lille'' (ZPL). The aim of the present work was to evaluate the completeness of the registry's first year of incident cancer registration (2005) and to compare the observed cancer incidence in the "ZPL'' with the estimated incidence in France.Methods. - Completeness was assessed using the average number of sources per case, the percentage of histological verification and a method of independent case ascertainment (mortality/incidence ratio). A direct standardization on the world population was used to calculate the ZPL/France ratios of standardized incidence rates. Analyses were conducted for 21 cancer sites.Results. - In 2005, 3635 cases of invasive cancer were recorded by the registry. The average number of sources per case was 2.7 and histological proof was available for 91.4% of cases. Mortality/incidence ratios showed satisfactory completeness of the data for men for most cancer sites. For women however, for cancer sites for which the number of cases was low, data will have to be confirmed during the subsequent years of observation. A lack of completeness was found for cutaneous melanoma. In men, an overincidence was identified for cancers of lip-mouth-pharynx, larynx, esophagus, lung, liver, bladder, kidney and colon-rectum. In women, an overincidence has been identified for cancers of lip-mouth-pharynx, liver, bladder, colon-rectum, corpus uteri and ovaries.Conclusion. - The first year of incidence validated at the "Registre general des cancers de Lille et de sa region'' shows a completeness of records with regards to studied criteria. The comparison with national data shows an overincidence of cancers related to tobacco and alcohol consumption in the geographical area covered by the registry. The incidence of lip-mouth-pharynx cancer in men is the highest of all French registries. (C) 2012 Elsevier Masson SAS. All rights reserved.

Étudier les inégalités sociales et territoriales de santé en matière d’hospitalisations pour complications podologiques (plaies du pied et amputations) chez les personnes diabétiques traitées pharmacologiquement, en France, en 2015.Les données ont été extraites du Système national d’information inter-régimes de l’assurance maladie (Sniiram) chainé au Programme de médicalisation des systèmes d’information (PMSI). Les personnes diabétiques traitées pharmacologiquement ont été identifiées sur la base des remboursements de traitements antidiabétiques. Les hospitalisations ont été sélectionnées à partir des actes codés selon la classification commune des actes médicaux pour les amputations d’un membre inférieur (AMI) et à partir des diagnostics principaux, reliés et associés des séjours pour les plaies du pied. Pour les plaies du pied, le premier séjour de l’année de chaque personne a été conservé. Pour les AMI, le séjour de l’amputation de niveau le plus proximal a été conservé. Afin d’établir des comparaisons régionales et selon le niveau socio-économique, les taux d’incidence ont été standardisés sur la structure d’âge de la population standard européenne (Eurostat), chez les personnes de 45 ans et plus.En 2015, en France, les taux d’incidence des hospitalisations pour AMI et plaie du pied dans la population diabétique étaient respectivement de 256/100 000 et 760/100 000 personnes traitées pharmacologiquement pour diabète. À structure d’âge identique, ce taux était 2,7 fois plus élevé chez les hommes que chez les femmes pour les AMI, et 1,6 fois pour les plaies du pied. Les taux étaient également plus élevés chez les personnes diabétiques de moins de 60 ans bénéficiaires de la couverture maladie universelle complémentaire (respectivement 1,7 et 1,4 fois plus élevés que chez les non bénéficiaires) et chez les personnes résidant dans les communes les plus défavorisées socio-économiquement (respectivement 1,4 et 1,3 fois plus élevés que chez ceux résidant dans les communes les plus favorisées par rapport aux résidents des communes les plus favorisées). Les disparités territoriales étaient, par ailleurs, très marquées.En 2015, en France, les hospitalisations pour complications podologiques restent très fréquentes dans la population diabétique, et de fortes disparités socio-économiques et territoriales sont observées. Cette étude souligne la nécessité de mettre en place, notamment dans les territoires identifiés à haut risque, des programmes d’éducation des patients et de les adapter à leur profil, des programmes d’information sur les forfaits podologiques pour prévenir les plaies, d’améliorer la formation des médecins sur le risque podologique et, d’autre part, de former des équipes pluridisciplinaires à la démarche thérapeutique permettant d’éviter les amputations.To provide an overview of socio-economical and territorial inequalities in hospitalizations for podiatric complications (foot ulcers and lower limb amputation [LLA]) in people pharmacologically treated for diabetes in France, in 2015.Data were extracted from the National information system for health insurance (Sniiram) linked to the French national hospital discharge databases (PMSI). People treated for diabetes were identified from their antidiabetic deliveries. Hospitalizations were selected from the acts coded using the common classification of medical acts for LLA and from the main, related or associated diagnosis of hospitalization for foot ulcers. For foot ulcer, the first annual hospital stay of each patient was retained. Regarding LLA, the hospital stay related to the most proximal amputation was retained. In order to perform territorial and socio-economical comparisons, incidence rates were age-standardized using the European standard population (Eurostat) in people aged 45 years and older.In 2015, in France, the incidence rate of people treated for diabetes hospitalized for LLA and foot ulcers were 256/100 000 and 760/100 000, respectively. The age-standardized rate of hospitalization for LLA was 2.7 times higher in males than in women. The rate for foot ulcer was 1.6 times higher in men. The rates were respectively 1.7 and 1.4 times higher in people with diabetes under 60 years of age who benefited from the universal complementary health cover (a deprivation marker) than in non-beneficiaries. They were respectively 1.4 and 1.3 times higher among people living in the most deprived towns compared to those living in the less deprived. Territorial disparities were very marked.In 2015, in France, hospitalization for podiatric complications are very frequent in the diabetic population and strong socio-economic and territorial disparities are observed. This study highlights the need to develop, especially in territories identified at high risk, patient education programs tailored to their profile. It also highlights the need to develop information programs on podiatric packages to prevent foot ulcers, better physician training for podiatric risk and, secondly, to form multidisciplinary teams to the therapeutic approach to prevent amputations.

Background. The aim of the study was to assess the accuracy of the colorectal-cancer incidence estimated from administrative data. Methods. We selected potential incident colorectal-cancer cases in 2004-2005 French administrative data, using two alternative algorithms. The first was based only on diagnostic and procedure codes, whereas the second considered the past history of the patient. Results of both methods were assessed against two corresponding local cancer registries, acting as "gold standards." We then constructed a multivariable regression model to estimate the corrected total number of incident colorectal-cancer cases from the whole national administrative database. Results. The first algorithm provided an estimated local incidence very close to that given by the regional registries (646 versus 645 incident cases) and had good sensitivity and positive predictive values (about 75% for both). The second algorithm overestimated the incidence by about 50% and had a poor positive predictive value of about 60%. The estimation of national incidence obtained by the first algorithm differed from that observed in 14 registries by only 2.34%. Conclusion. This study shows the usefulness of administrative databases for countries with no national cancer registry and suggests a method for correcting the estimates provided by these data.

Introduction: This study aimed at modelling the effect of organized breast cancer screening on mortality in France. It combined results from a Markov model for breast cancer progression, to predict number of cases by node status, and from relative survival analyses, to predict deaths. The method estimated the relative risk of mortality at 8 years, in women aged 50-69, between a population screened every two years and a reference population. Methods: Analyses concerned cases diagnosed between 1990 and 1996, with a follow-up up to 2004 for the vital status. Markov models analysed data from 3 screening programs (:300,000 mammographies) and took into account opportunistic screening among participants to avoid bias in parameter's estimates. We used survival data from cancers in the general population (n = 918, 7 cancer registries) and from screened cancers (n = 565, 3 cancer registries), after excluding a subgroup of screened cases with a particularly high survival. Sensitivity analyses were performed. Results: Markov model main analysis lacked of fit in two out of three districts. Fit was improved in stratified analyses by age or district, though some lack of fit persisted in two districts. Assuming 10% or 20% overdiagnosed screened cancers, mortality reduction was estimated as 23% (95% CI: 4, 38%) and 19% (CI: -3, 35%) respectively. Results were highly sensitive to the exclusion in the screened cancers survival analysis. Conversely, RR estimates varied moderately according to the Markov model parameters used (stratified by age or district). Conclusion: The study aimed at estimating the effect of screening in a screened population compared to an unscreened control group. Such a control group does not exist in France, and we used a general population contaminated by opportunistic screening to provide a conservative estimate. Conservative choices were systematically adopted to avoid favourable estimates. A selection bias might however affect the estimates, though it should be moderate because extreme social classes are under-represented among participants. This modelling provided broad estimates for the effect of organized biennial screening in France in the early nineteen-nineties. Results will be strengthened with longer follow-up. (C) 2010 Elsevier Ltd. All rights reserved.

Objectives To describe circumstances of the diagnosis and access to dermatological care for patients with cutaneous melanoma (CM) and to investigate factors associated with early detection. Design Retrospective population-based study of incident cases of invasive CM in 2004, using questionnaires to physicians and a survey of cancer registries and pathology laboratories. Setting Five regions in northeastern France. Patients Six hundred fifty-two patients who were referred to dermatologists by general practitioners (group 1) or by other specialists (group 2), who directly consulted a dermatologist for CM (group 3), or who were diagnosed as having CM during a prospective follow-up of nevi (group 4) or when consulting a dermatologist for other diseases (group 5). Main Outcome Measures Characteristics of patients, tumors, and patients' residence in each group, including the geographical concentration of dermatologists. We performed multivariate analysis of these factors to determine association with Breslow thickness. Results Age, tumor location, Breslow thickness, ulceration, histological type, and geographical concentration of dermatologists significantly differed among groups. Patients consulting dermatologists directly formed the largest group (45.1%). Those referred by general practitioners (26.1%) were the oldest and had the highest frequency of thick (>3 mm), nodular, and/or ulcerated CM. Patients from groups 4 (8.4%) and 5 (14.1%) had the thinnest CMs. Ulcerated and/or thick tumors were absent in group 4. In multivariate analysis, histological types superficial spreading melanoma and lentigo maligna melanoma, younger age, high concentration of dermatologists, and detection by dermatologists were significantly associated with thinner CMs. Conclusion Easy access of patients to dermatologists, information campaigns targeting elderly people, and education of general practitioners are complementary approaches to improving early detection.

La rupture du LCA représente une des lésions les plus fréquentes et les plus graves du genou, en particulier dans le cadre de la pratique sportive. Le traitement chirurgical par plastie ligamentaire représente l'option la plus fréquente, permettant de stabiliser le genou, de prévenir l'instabilité, mais ne permettant pas d'empêcher l'évolution vers l'arthrose. C'est pourquoi les programmes de prévention ont été proposés et évalués pour plusieurs sports, et en particulier le football. Une bonne compliance et une information complète des entraîneurs sont indispensables à la réussite de ces programmes.ACL rupture represents one of the most common and serious injuries of the knee, particularly in sport practice (football, hand-ball, rugby, judo, ski). The incidence as dramatically increased during the last decades. Surgical treatment is the most frequent option, which stabilizes the knee, prevents instability, but unfortunately, does not the arthrosis. In consequence, prevention programs have been proposed and evaluated in some sports, particularly in football. A good compliance and an information to the trainers are necessary to obtain the best results.

ummary ackground. — Although clinical trials have demonstrated that adjuvant chemotherapy improves urvival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The bjective of the present study was to determine the extent to which adjuvant chemotherapy s used for patients with stage-II and -III colon cancers. ethods. — The study population comprised 1074 patients with stage-II and -III colon cancers iagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer egistries. Data were collected using a standardized procedure. esults. — Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant hemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stageI patients, those receiving chemotherapy decreased from 57.6% in patients aged ≤ 50 years to .1% in those aged ≥ 85. The corresponding percentages with stage III were 93.6% and 1.4%. n multivariate analyses, other factors found to be independently and significantly associated ith administration of adjuvant chemotherapy for stage II were extension of the cancer (stage IA vs. stage IIB), clinical presentation (obstruction or perforation vs. uncomplicated cancer) nd discussion of the case at a multidisciplinary case-review meeting. For stage III, apart from ge, discussion of the case at a multidisciplinary meeting was the only factor independently ssociated with administration of chemotherapy. onclusion. — Adjuvant chemotherapy for stage-III colon cancer is used extensively for patients nder 75 years of age. However, many elderly patients do not receive such treatment. On

Cancer incidence in France is monitored by district-level cancer registries, which cover only 15% of the population. Incidence at the national and regional level are estimated from mortality data by extrapolating the ratio between incidence and mortality observed in the districts covered by a cancer registry. Using the incidence/mortality ratio might not be relevant at the district-level (département). This study aims to produce district-level estimations of colorectal cancer incidence, using the ratio between incident cases from cancer registries and surgery admissions for colorectal cancer identified in the national hospital discharge database.This ratio was studied for the period 1999–2003 in the 13 districts covered by a cancer registry. For each sex separately, the number of incident cases was analyzed according to the number of surgery admissions for resection of colorectal cancer using a Poisson model. Age was introduced in the model as a fixed effect and district as a random effect. The model's ability to predict incidence was tested through cross-validation. The model was then extrapolated in order to estimate incidence of colorectal cancer in all French districts.In the districts covered by a cancer registry, cross-validation showed the model had a good predictive ability, except in men for one district where the difference between predicted and observed incidence reached 10%. Estimated incidence rates, age-standardized on the world population, ranged broadly from 29 to 44 per 100,000 in men and from 17 to 27 per 100,000 in women. Incidence did not show any clear geographical pattern.Among districts covered by a cancer registry, cross-validation showed overall good accuracy of predicted incidence. Inclusion of several admissions per patient was certainly a minor source of error in these estimations. Indeed, our selection only included 2% of multiple admissions, without geographical variations, in 2002 and 2003, years for which patient identifiers were available in the hospital discharge database. Estimated incidence rates presented moderate geographical variations and their prediction intervals should be taken into account.En France, l'incidence des cancers est mesurée par les registres départementaux des cancers qui couvrent 15 % de la population. L'incidence des cancers est estimée au niveau national et régional à partir des données de mortalité en extrapolant le rapport entre incidence et mortalité observé dans les départements couverts par un registre. L'utilisation du rapport incidence/mortalité au niveau départemental est plus incertaine. Cette étude a pour objectif de produire des estimations départementales de l'incidence du cancer colorectal en France, à partir du rapport entre nombre de cas incidents et nombre de séjours chirurgicaux répertoriés dans les bases hospitalières.Ce rapport a été étudié sur la période 1999–2003 dans les 13 départements couverts par un registre. Pour chaque sexe séparément, le nombre de cas incidents a été analysé en fonction du nombre de séjours chirurgicaux pour résection du cancer colorectal (colectomies, exérèses, pelvectomies) par un modèle de Poisson. L'âge a été intégré au modèle en effet fixe et le département en effet aléatoire. La capacité du modèle à prédire l'incidence a été testée par validation croisée. Le modèle a ensuite été extrapolé pour estimer l'incidence départementale.Dans les départements couverts par un registre, la validation croisée a montré une bonne capacité prédictive du modèle, à l'exception chez l'homme d'un département où l'écart entre incidence prédite et observée atteignait 10 %. Sur l'ensemble des départements, les taux d'incidence estimés, standardisés sur la population mondiale, variaient de 29 à 44 pour 100 000 environ chez l'homme et de 17 à 27 pour 100 000 chez la femme. L'incidence ne présentait pas de gradient géographique clair.Au sein des registres, l'incidence prédite en validation croisée était proche dans l'ensemble de l'incidence observée. L'inclusion de plusieurs séjours par patient représentait certainement une source d'erreur mineure dans ces estimations. En effet, notre sélection ne comportait que 2 % de séjours multiples, sans variations géographiques, en 2002 et 2003, années pour lesquelles le chaînage patient était disponible dans les bases hospitalières. Les taux d'incidence estimés présentaient des variations géographiques modérées. Les intervalles de prédiction qui les accompagnent doivent être pris en considération.

Introduction. - Prostate cancer was the most common cancer in men in France in 2005, and the second cause of mate death from cancer. In this study, we analyzed clinical characteristics of patients with prostate cancer diagnosed in France in 2001 with a focus on therapeutic management of localized prostate cancers.Patients and methods. - A total of 2181 cases of prostate cancer diagnosed in 2001 from 11 French counties covered by a cancer registry were analyzed. A descriptive study of the clinical characteristics of patients was performed. Parameters studied included age, county, TNM stage, PSA value, Gleason score, D'Amico prognostic group, Charlson's comorbidity index and initial treatment modalities. For localized cancers, multivariate logistic regression analysis identified factors associated with radical prostatectomy.Results. - The proportion of localized prostate cancer (T1 or T2) was 86.6%. The use of invasive curative treatment (radical prostatectomy and radiotherapy) was 58.4% for Localized cancers. Significant differences in therapeutic management were found between counties. Radical prostatectomy was associated with age at diagnosis, D'Amico prognostic group and the presence of comorbidities.Conclusions. - Most of prostate cancers diagnosed in France in 2001 were clinically localized and were treated by invasive therapy. The consequences of these practices remain to be determined given the limited evolution of many prostate cancers and the frequency of adverse events related to invasive treatments. (C) 2009 Elsevier Masson SAS. All rights reserved.

cancer, and the general population, respectively (0 = worst; 52 = least fatigue). Ten-year total per patient costs (drug, monitoring, physician visits, adverse events) for managing GIST patients with molecularly targeted treatment were estimated at £47,086– £70,811 compared to £3674–£4230 with best supportive care. CONCLUSIONS: Data suggest the incidence of GIST is similar across countries; lower incidence in one study is likely explained by differences in method of case ascertainment. Although patients with GIST present with fatigue comparable to other cancers, additional research is needed to comprehensively understand its HRQL burden. The increased cost associated with new therapies must be balanced against their expected benefits.

Background. There are few epidemiological data available on rare skin cancer, including Merkel cell carcinoma, Paget's disease, adnexal carcinoma, and sarcoma. We conducted this study to investigate the epidemiological of rare skin cancer diagnosed in the département of Doubs from 1980 to 2004. Methods. Data were collected from a population-based cancer registry from 1980 to 2004. Diagnosis was based on the 3rd edition of the International Classification of Diseases for Oncology. The incidence rates were standardized on world population. Results. One hundred and fifty one patients were investigated (88 women and 63 men). Median age for the diagnosed disease was 63 years. The standardized incidence rate was 0.82/100 000 person-year (95% CI = 0.68–0.96) and increased from 0.25 in 1980–1984 to 1.50 in 2000–2004. Fifty nine cases (39%) were sarcomas, 35 (23%) adnexal carcinomas, 27 (18%) Merkel cell carcinoma and 27 (18%) Paget's disease. The standardized incidence rates were 0.37/100 000 (0.27–0.47) for sarcomas, 0.16 (0.10–0.22) for adnexal tumors, 0.13 (0.08–0.18) for Merkel cell carcinoma, and 0.15 (0.09–0.21) for Paget's disease. Conclusions. Our results based on a population-based cancer registry showed an increase of the standardized incidence rate for all types of rare skin tumors. These results may be useful when considering the growing interest in rare diseases in identifying risk factors and planning scientific research programmes.

The evolution of pleural cancers and malignant pleural mesothelioma incidence in France between 1980 and 2005 was analysed using data derived from the French network of cancer registries (FRANCIM) and the French National Mesothelioma Surveillance Program (PNSM). Mesothelioma proportions in pleural cancers were calculated by diagnosis year in the 1980-2000 period. Our results suggest that the incidences of pleural cancer and mesothelioma levelled off in French men since 2000 and continued to increase in French women. A decrease of the annual pleural cancer incidence average in men was noticed (-3.4% of annual rate of change) between 2000 and 2005. The proportion of pleural cancers that were mesothelioma was unchanged between 1980 and 2003 with an average of 86%. The age standardised incidence rate of pleural mesothelioma remained relatively stable between 1998 and 2005 with a slight falling trend. For women, the age standardised incidence rate of pleural cancers and mesothelioma increased during the period 1998-2005. Additionally, the proportion of pleural cancers that were mesothelioma increased during the same period of time. Finally, the increased trend observed in the incidence of pleural mesothelioma and cancers in women is credibly due to their under diagnosis in the 1980-1997 period. The comparison between the French incidence and the American and British ones shows that the decreasing trend in incidence of mesothelioma and pleural cancers in French men since 2000 is potentially associated with a lower amphibole consumption and by the implementation of safety regulations at work from 1977.

Population-based registries provide excellent data for drawing an accurate picture of disease management practices. The purpose of this study was to determine whether diagnostic and therapeutic management practices for rectal cancer vary in different geographic regions of France.Data issued from nine cancer registries covering 11% of the French population. The files of 683 patients with a rectal cancer diagnosed in 1995 were selected for analysis.Colonoscopy was performed in a mean of 91.6% of patients (range: 80.9%-98.2%) (P = 0.01). The practice of colonoscopy concomitantly with barium enema varied greatly, ranging from 1.9%-57.7% of patients (P < 0.001). Pretherapeutic work-up practices were significantly different depending on the region with respect to: abdominal CT scans (13.4%-69.2 %), thoracic CT scans (0.9%-13.2%) and tumor markers (46.8%-80.8%). There were no significant differences between geographic regions concerning rate of resection, use of colostomy, or tumor stage at diagnosis. Administration of adjuvant radiotherapy (mean, 46.8%; range: 21.6%-70%; P < 0.001) and adjuvant chemotherapy (mean, 24.1%; range: 10.3%-40.6%; P < 0.05) varied significantly between regions.Diagnostic practices and administration of adjuvant treatments vary significantly between geographic regions in France. The recommendations of the French consensus guidelines are only partially adhered to. Practitioners and healthcare authorities should be aware of these differences in order to provide more harmonious patient care.Les études de population portant sur des données de registres représentent le meilleur moyen de savoir comment une pathologie est prise en charge. L'objectif de cette étude était de déterminer s'il existait des différences régionales dans la prise en charge diagnostique et thérapeutique du cancer du rectum.Au total, 683 malades avec un diagnostic de cancer du rectum porté en 1995 ont été étudiés. Les données étaient issues de 9 registres départementaux de cancers couvrant 11 % de la population française.La coloscopie a été faite dans 91,6 % des cas en moyenne avec des extrêmes allant de 80,9 % à 98,2 % (P = 0,01). La réalisation concomitante d'une coloscopie et d'un lavement baryté était très hétérogène avec des extrêmes allant de 1,9 % à 57,7 % (P < 0,001). Pour le bilan pré-thérapeutique, il existait des différences significatives dans la réalisation des scanners abdominaux (variations entre 13,4 % et 69,2 %) et thoraciques (entre 0,9 % et 13,2 %) et des marqueurs tumoraux (entre 46,8 % et 80,8 %) entre les départements. Il n'y avait pas de différence significative inter départementale pour le taux de résection, la réalisation d'une stomie ou le stade au diagnostic. En revanche, il y avait des variations significatives pour la pratique de la radiothérapie adjuvante (en moyenne 46,8 % avec des extrêmes de 21,6 % à 70,0 %; P < 0,001) ou la chimiothérapie adjuvante (en moyenne 24,1 % avec des extrêmes de 10,3 % à 40,6 %; P < 0,05).Il existe des différences inter départementales importantes en ce qui concerne les pratiques diagnostiques et les traitements adjuvants. Les recommandations de la Conférence de Consensus n'apparaissent que partiellement suivies. Ces résultats doivent alerter la communauté médicale et les autorités sanitaires afin de rendre les pratiques plus homogènes.

OBJECTIVE:To describe current management of cutaneous melanoma (CM) and identify factors accounting for disparities.DESIGN:Retrospective population-based study using survey of cancer registries and pathology laboratories, and questionnaires to physicians.SETTING:Five regions covering 19.2% of the French territory and including 8.2 million inhabitants.PATIENTS:Incident cases of patients with stage I to stage II (hereinafter, stage I-II) tumors staged according to the American Joint Committee on Cancer Staging guidelines and nodal stage III CM in 2004.MAIN OUTCOME MEASURES:Modalities of diagnosis and excision, surgical margins, sentinel lymph node biopsy, adjuvant therapies and surveillance procedures, and their variations according to age, sex, residence, location of primary CM, Breslow thickness, type of physicians, modalities of decisions, and health care patterns.RESULTS:Clinical stage I-II CMs (n = 710 cases) slightly predominated in females (53%), with a lower mean Breslow thickness (1.4 mm) than in males (1.9 mm). Initial excisions were most often performed by private dermatologists and wide excisions by surgeons. Narrow margins (8%) were associated with advanced age, higher Breslow thickness, and head location. Sentinel lymph node biopsy was performed in 34% of CMs thicker than 1.0 mm, depending on geographical regions, distance from reference centers, and health care patterns. Adjuvant therapies (mainly low-dose interferon) were proposed in 53% of thick CMs (>1.5 mm), depending on the patient's age and geographical region. In contrast with French recommendations, surveillance procedures frequently included systematic medical imaging. Stage III nodal CMs (n = 89 cases) predominated in males (62%). After lymphadenectomy, adjuvant therapies (including high-dose interferon in 32% of cases and chemotherapies in 24% of cases) were proposed in 68% of cases, depending on the patient's age and geographical region. A complete 1-year high-dose interferon regimen was administered in less than 10% of cases.CONCLUSION:Large disparities still exist in the management of CM in France, depending to a greater extent on medical and geographical environment than on the characteristics of either patients or tumors.