Optimizing time and care coordination for melanoma patients in the Onkonetwork system

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The aim of this publication is to present the oncological care of patients with melanoma in Hungary's first oncology patient pathway management system. The OnkoNetwork system was developed and implemented in 2015 in Moritz Kaposi General Hospital in Somogy County, where the authors followed the care of 670 patients with melanoma among thousands of oncology patients. The system monitored the process and time management of melanoma patients' care from the time of suspicion to the time of closure. The diagnosis, oncological treatment and follow-up of patients are governed by standardized protocols. The system ensures that patients are seen and diagnosed within 21 days. The Oncoteam, within 30 days of entering the system, decides on the patient's further investigation and treatment, and treatment starts within 14 days of the Oncoteam's decision. The importance of the OnkoNetwork system is, first and foremost, to provide uniform, protocol-driven care, redirect "lost" patients and reduce delays due to anomalies in the healthcare system. With the use of a patient pathway management system, the diagnosis, treatment and follow-up of melanoma patients are prioritized. integrated oncology care melanoma OnkoNetwork oncology patient pathway management patient-centred care time management Figures Figure 1 Figure 2 Introduction Epidemiology and significance of melanoma The steep increase in the incidence of melanoma makes oncology patient pathway management for melanoma patients a priority. Over the past two decades, the incidence and mortality of melanoma have doubled, especially in countries with light-skinned populations of European descent. (1, 2) In the United States, a threefold increase in incidence has been observed. (3) Compared with that of any other malignancy, the incidence of melanoma is increasing faster in both sexes, except in women, where the increase is primarily due to lung cancer. (4) GLOBOCAN estimated incidence and mortality data show that in 2022, melanoma was the 17th most common malignancy worldwide, with 331,647 cases per year. In terms of mortality, it was the 22nd-ranked malignancy, with 58,645 cases per year. In Hungary, melanoma was the 11th most common malignancy in 2022 (5, 6, 7, 8). According to the data of the National Cancer Registry, in line with international trends, the incidence of melanoma in Hungary is increasing dramatically, with the number of new cases doubling in the last two decades, reaching nearly 3,000 per year. Melanoma causes 300–400 deaths per year in Hungary. (9) A Hungarian real-world retrospective analysis of melanoma management (RAMM) confirmed this finding, revealing a significant reduction in mortality in the overall melanoma population. (10) The MIR of melanoma in Hungary is the lowest in Central and Eastern Europe and comparable to that of Western and Northern European countries. (11) Melanoma care guidelines and issues A European consensus-based interdisciplinary guideline on the care of patients with melanoma details the guidelines for the diagnosis of melanoma, including time management of follow-up and care. (12) The consensus also sets out treatment guidelines (13), which are followed by national surgical standards. A dermatologist should examine the suspected lesion, which should then be surgically removed as soon as possible (within 2–4 weeks) with an intact zone of 1–3 mm (14). The guidelines and standards of care for patients with melanoma in Europe and at home are therefore well defined, evidence-based and consensus-based. Domestic studies have shown that the main problem for oncology patients is not the quality of treatment. For patients, one of the greatest problems is the time from suspicion to diagnosis and the organization and coordination of examinations and appointments. (15) Patients feel 'lost', left to their own devices in the system. They suffer from a lack of information, do not know what will happen to them and when, and lack a detailed treatment plan. (16) This was confirmed by a comprehensive, systematic, international review of the unmet needs of cancer patients. Researchers have concluded that the second greatest problem for cancer patients, after psychological/emotional support, is access to the health care system/information (17). Several international studies have shown that oncology care and patient pathway organization increase the chances of appropriate healthcare, shorten waiting times, improve access, and facilitate capacity management, thus increasing patient safety and patients' chances of recovery. On the basis of the results of a meta-analysis by S.S. Gorin and colleagues, the coordination of oncology care resulted in 81% improvements in outcomes, from screening to treatment to the quality of end-of-life care (18). For patients with melanoma, not only early detection and treatment but also care and follow-up are important, as individuals with a history of melanoma are at risk of developing metastases and subsequent melanoma recurrence. (19, 20, 21, 22) Therefore, patient-centred, integrated oncology care is of paramount importance for patients with melanoma. Background of the OnkoNetwork oncology patient pathway management system The development and establishment of the OnkoNetwork, an oncology patient pathway management system, represents a paradigm shift in Hungarian oncology care. There are similar case management systems in international practice, but the Kaposvár model is the first in Hungary. (23) The essence of the OnkoNetwork is single, comprehensive, integrated oncology care based on a protocol system. The main objective is to ensure that patients with a suspected oncological diagnosis are not lost in the care system and receive diagnosis and treatment within a given time, with priority in the system of the institution, ensuring early diagnosis and curative therapy. Long-term goals included the development of a valid, prospectively collected oncology database that would allow for a real analysis of morbidity and mortality, as well as the involvement of cancer screening and the primary care system. The OnkoNetwork office, which is the hub of networking, was established with human and financial resources. Innovative professional roles have been introduced for nonphysicians and physicians (24, 25, 26). Three basic time-related indicators are defined, which represent the optimal expected time (Figure 1). The patient should be diagnosed within 21 days of disease onset (with suspected institutional melanoma). OnkoTeam must make a decision on the patient within 30 days of the start of the case. Treatment should start within 14 days of the OnkoTeam decision. The increase in the number of publications on melanoma is far behind the dramatic increase in the number of melanoma patients (4), making this topic of paramount importance. This publication presents and critically examines the oncology patient pathway management system applied in the care of melanoma patients. The authors aim to introduce an innovative framework and provide a practical, evidence-based example of integrative oncology care in the context of melanoma. Study design and sampling The study analysed the oncological care pathways of 670 patients diagnosed with malignant melanoma (ICD-10: C43) and melanoma in situ (ICD-10: D030) and treated at Moritz Kaposi General Hospital and within the OnkoNetwork system between 1 October 2015 and 31 December 2023. The data sources included the e-MedSolution hospital IT system and OnkoLogistic software (Trademark registration number M1601197/4). During the development process, OnkoLogistic was replaced by the OnkoNetwork system, which was integrated as a medical module within e-MedSolution. Background data and the phases of the oncology patient pathway management system were analysed via descriptive statistical methods. Study cohort: A total of 670 patients with malignant melanoma (ICD-10: C43) or melanoma in situ (ICD-10: D030) were enrolled in the OnkoNetwork during the study period. Among these, 52% (n=350) were female, and 48% (n=320) were male. The majority of patients were aged 60–79 years. Among the histological subtypes, 54% were superficial spreading melanomas, 19% were nodular melanomas, 11% were lentigo maligna melanomas, 2% were acral lentiginous melanomas, and 14% were other melanoma types. The tumor thickness distribution revealed 19% in situ melanomas, 35% thin (4 mm). The most common stage was IA (28.51%), followed by Stage 0 (20.9%), IB (11.94%), IIB (10.35%), IIA (8.06%), IV (8.06%), III (6.87%), and IIC (5.07%). Methods Four phases have been identified in the process: investigational, oncological, therapeutic and follow-up. Table 1 shows the phases and events in the care of melanoma patients. The status of the phases was examined according to the status downloaded on 29 January 2024. Performance indicators and process indicators were defined for clinical quality assessment. The implementation of phases and time management were monitored and compared with the time limits required by the system. The care process from the first clinical suspicion to the closure of the case was analysed. Clinical quality indicators for melanoma from studies in northern Sweden (27) and Scotland (28) were used as examples for the evaluation. IBM SPSS Statistics 25.0 software was used for analysis. Results Phases of oncological care: Of the 670 patients diagnosed with melanoma, 170 patients (25.37%) were in the investigational phase, 24 (3.58%) were in the Oncoteam phase, 77 (11.49%) were in the therapeutic phase, and 399 (59.55%) were in the follow-up phase (Table 2). A total of 349 patients (52.09%) were in the active phase, 45 patients (6.72%) were in the suspended phase, and 276 patients (41.19%) were in the closed phase. Among the patients in the closed phase, 119 patients were permanently closed, 104 of whom were closed because of patient death. Process Quality Performance Indicators (PQPIs): QPI. 1. OnkoNetwork recording: Registration of the patient in the OnkoNetwork system with a suspected or confirmed histological diagnosis of melanoma. 100% met. A total of 41.49% of patients were admitted with suspected melanoma, and 58.51% had confirmed histological diagnoses. The confirmed histopathological diagnosis was an external diagnosis from another institution in 220 (32.83%) patients and a local histopathological diagnosis in 172 (25.67%) patients. Cases admitted with suspected melanoma (278 cases, 41.49%) were later confirmed by histopathology. QPI. 2. Pathology report: Percentage of patients with cutaneous melanoma who underwent diagnostic excision (excision) and confirmed a melanoma diagnosis via histology. 100% met. A total of 32.83% (220) of patients with melanoma presented with histology results, and 67.16% (450) had local institutional histology. QPI. 3. Every oncology patient should have their own oncology doctor: 100% met. QPI.4. Investigation and diagnosis were performed within 21 days of the start of the case . In 66.41% of patients admitted with suspected melanoma, the diagnosis of melanoma was confirmed by histology within 21 days. A total of 84.77% of patients received a confirmed diagnosis within one month. Table 3 QPI. 5. Oncoteam decision within 30 days of the start of the case: Out of 670 melanoma patients, a total of 513 (76.56%) had their first Oncoteam session at the Institute. A total of 102 cases required a 2nd Oncoteam session, 24 cases required 3, 10 cases required 4, and 1 case required 5 Oncoteam sessions. Among the 513 Oncoteam meetings, 227 cases (44.24%) were held within 30 days of the start of the case. A further 169 patients were selected within 60 days. There was no oncological meeting at the institution for the following cases: 126 in situ melanoma cases (18.8%). In 15 cases, the patient was referred to another institution for Oncoteam (2.2%), and 16 cases without Oncoteam were included in the reference period (2.3%). QPI.6. Therapy was started within 14 days of the first Onkoteam decision: 339 patients were reexcised. Among these patients, 113 patients started oncological care after reexcision. A total of 226 patients underwent reexcision in combination with sentinel lymph node scan and/or block dissection. In 219 patients, no other intervention was needed, so oncological care was started. In 9 other cases, radical surgical treatment was performed (3 of which were amputations), and sentinel lymph node examination and/or block dissection were performed. In 25 patients, other therapies were ordered after excision (radiotherapy, interferon, PD-1 treatment, treatment of metastases, etc.), and further investigations were ordered in 25 patients. Forty-six patients were referred to another institution (Melanoma Centre) for further care. A total of 7 patients did not receive further oncological care (the patient did not return, was not fit for further treatment or was referred to hospice care). If additional therapy was ordered, the therapeutic phase started immediately after the Oncoteam decision was reached. QPI. 7. Tracking: At the time of the study, 59.55% of the 670 patients were in the follow-up phase. Of these, 399 were actively followed up, 23 were suspended, and 70 were closed. During oncodermatological care and observation, 55 patients (8%) developed new melanoma, and 18 patients (3%) developed subsequent metastasis. Discussion In Hungary, the diagnosis and treatment of melanoma patients essentially starts with specialist dermatology services. The basic route is as follows: Suspicious lesion detection (patient, GP, occasional screening programmes, other specialist care, etc.). If a suspicious lesion is found, a dermatologist should be consulted to confirm the suspicion of melanoma and/or recommend removal of the suspicious lesion for differential diagnosis. Without a dermatological examination and recommendation, removal of the suspicious lesion would not be possible today. Depending on the location, size and shape of the suspected lesion, it may be removed (excision) by a dermatologist, surgeon, plastic surgeon, oral surgeon, ear, nose and throat specialist or a specialist surgeon in the area concerned. According to professional protocols, punch incisional biopsy can be performed only if the tumor is large and difficult to remove or if the anatomy does not allow excision. Otherwise, punch incisional biopsy of the melanoma is prohibited. Histological examination of all removed samples is mandatory. The results of the histopathology examination are sent to the submitting dermatologist or surgeon, the patient can see them in the electronic health service space, and the patient's GP can also view them. With the histopathology result, the patient should return to the dermatologist, who will order the next steps according to the protocol. Depending on the histopathology, oncological or further treatment, for example, reexcision with specific margins, excision with sentinel lymph node scan/bloc dissection, radical surgery, or initiation of oncodermatological care. Care and tracing are then carried out according to the protocol and the decision of the Oncoteam. The care and chances of patients with melanoma depend largely on when they enter the care system, when and where they are seen by a dermatologist, and when the suspected lesion is removed. The OnkoNetwork system is a unique way to support integrated oncology care for all cancer patients. It currently manages the active oncology care of 13,484 out of 12,487 patients. The system provides the possibility to access detailed information on individual cancers and to evaluate the progress of care, even by type of cancer. This provided the opportunity for a system-wide analysis of the care of 670 melanoma patients. The results confirm that the management of the oncological pathway of melanoma patients is a highly complex and multifaceted process. However, owing to the system, the phases of care, events, turnaround times, tasks and roles are well controlled and traceable (Figure 2). As this was the first and for a long time the only oncology patient pathway management system and no such studies or publications have been performed or are available in Hungary, we cannot compare our results with data from other institutions. In this study, we conducted a self-assessment of the process and an evaluation of the quality indicators we established. The first three quality indicators (QPIs 1, 2, and 3) were met in all patients with melanoma. Thus, all melanoma patients with suspected or diagnosed melanoma are enrolled in the Onko Network at first hospital admission or within 24 hours of admission. This is ensured by the system's automatic notifications, alerts and the OnkoNetwork office staff. A diagnosis of melanoma can be confirmed only by a histopathology result; therefore, all patients with melanoma have a histopathology result. All patients with melanoma have an oncology doctor, as the care of melanoma patients at our hospital is provided by dermatologists who are also board certified in oncology. We found differences in the process and timing of care, depending on whether the patient came to the hospital with an external suspicion or diagnosis or whether their care started in the hospital. On average, the time between the date of external suspicion and diagnosis (QPI.4: have a histological diagnosis within 21 days) was two to three times longer than in cases where the initial care (screening or examination of the suspicious lesion) started in the hospital. For those presenting with an external suspicion or an external histopathology, it was therefore not possible to assess the time interval between the discovery of the case and the histopathology. For the patients included in the analysis, 66.41% of patients reached diagnosis within 21 calendar days. The rate is more favourable when the expected 21-day time frame is supplemented by a minimum tolerance period (taking into account that holidays and weekends are included in the 21 calendar days). When a 1-month time interval is considered, nearly 90% of patients reach a histopathology-confirmed diagnosis of melanoma. For the second indicator, the time to make an Onokteam decision within 30 days of the start of the case (QPI 5), the 30-day deadline was met in nearly half of the cases. The majority of patients for whom an Onkoteam decision was made after 30 days were stage IA patients. We found that the reasons for Onkoteam decisions beyond 30 days included delays in the date of reexcisio and the implementation of further investigations, especially during the COVID-19 epidemic. For histologically confirmed in situ melanomas, the protocol allows the Oncoteam session to be waived if the excision is of sufficient width and depth. In most of these cases, excision is in itself a therapy. For this reason, among others, the use of the QPI indicator 6 to start therapy within 14 days of the Oncoteam decision is again a nuanced assessment for patients with melanoma. In 32.68% of patients, no further oncological intervention was required after the first excision, in which case follow-up and oncological care were started. Half of the patients also did not require further oncological intervention after reexcision (with or without sentinel lymph node scan). Overall, 83.28% of patients did not require any further therapy other than surgery. For the remaining patients, the therapeutic phase started immediately after the Oncoteam decision, including if the patient was referred to another institution. The last of the process indicators is the assessment of follow-up (QPI 7). At the time of the survey, nearly 60% of the patients were already in the follow-up phase. In Hungary, the follow-up and oncodermatological care of melanoma patients is provided entirely by specialized care (hospital dermatology). However, the involvement of general practitioners is very important in reaching and tracing patients if they do not attend their prescribed examinations. During the follow-up, 55 patients developed new melanoma, and 18 patients developed subsequent metastasis during the period under review, which highlights the importance of an integrated oncology care management system. The introduction of a uniform oncology patient pathway management system would be a prerequisite for a nationwide, comprehensive quality assessment of oncology care for melanoma patients. For the evaluation of the system, uniform criteria and quality indicators should be defined, similar to the basic requirements of the ECCO (European CanCer Organization) for access to quality cancer care (29). Conclusions The OnkoNetwork network builds on the traditional oncology care system, clearly improving its functioning and organization and directly supporting and treating each patient. Notably, OnkoNetwork is a process management system and database integrated into the day-to-day running of hospitals. The advantage of this approach is that no patient admitted with suspected melanoma is lost in the course of care, thus significantly reducing the critical time delay from suspicion to histological diagnosis in melanoma patients. It also has the advantages of prioritizing the critical points of oncology patient care, entry into the system, clinical trials and follow-up. The OnkoNetwork system not only facilitates early treatment but also provides consistent oncological care for all patients, including those with melanoma or other malignant skin tumours. Our study provides a stopgap, practical example of how the system works and what data it can store and act as a "register". Each step is traceable, and the system's automatic alerts help ensure that the defined phases, tests, interventions and time indicators are achieved. According to the system, 66.41% of melanoma patients receive a diagnosis within 21 calendar days, and almost 90% receive a diagnosis within one month. The Onkoteam decision is made within 30 days for nearly half of patients, and if therapy other than surgery is ordered, the therapeutic phase starts immediately after the Onkoteam decision. In addition to encouraging results, continuous improvement, monitoring and training of professionals working in the system is essential. Our study highlights the need to place greater emphasis on collaboration with GPs in the early detection of melanoma, accelerating vertical patient pathways. For those presenting with an external suspicion, efforts should be made to establish a diagnosis within 21 days and to implement an Oncoteam decision within 30 days. This is the first publication in Hungary to analyse and present the oncology care pathway for patients with melanoma. This study provides a good example of how an oncology patient pathway management system can facilitate the follow-up of melanoma patients for up to 10 years or for life. The greatest benefit—clearly—is for the patient, who is "held by the hand" throughout care and treatment. It is not lost in the system if your doctor changes, nor if you forget when you need to go for a check-up. Another benefit for patients is that they are assured of consistent quality, protocol-based care that all patients receive equally. At the same time, it has also been extremely useful for doctors, who have had to care for hundreds of patients with melanoma over the years and decades. For their part and for specialist care, such a support system is essential to ensure that all their patients are properly cared for. The system also provides the hospital with a particular economic and operational advantage, as it makes it possible to review, monitor, plan and control the examination and care of oncology patients. The use of the Onkonetwork system in other hospitals would be a potentially useful tool for evaluating the performance and quality of care provided to patients treated for melanoma or any other type of cancer. Quality performance indicators (QPIs) in healthcare increase patient safety and outcomes, improve care quality, increase transparency and accountability, improve operational efficiency, support financial health, inform policy and management, and enable benchmarking and learning. ( 30 ) Limitations of the study This study has several limitations. This study was conducted at a single institution, which may limit generalizability. The observational design without a control group restricts causal interpretation. The analysis focused mainly on process indicators rather than long-term outcomes such as survival or quality of life. The patient cohort, while sizeable, may not represent all melanoma cases. Finally, standardized protocols, although ensuring consistency, may reduce flexibility for atypical or complex cases. Declarations Ethics approval: The research was carried out with the permission of the Moritz Kaposi General Hospital Institutional Ethics Committee. Human Ethics and Consent to Participate declarations: All procedures involving human participants were conducted in accordance with institutional and national ethical standards and fully complied with the principles of the Declaration of Helsinki. Participation in Onkonetwork‑supported care pathways required written informed consent. Patients provided their consent through individual consent forms, acknowledging that they had received adequate information about the purpose and operation of the Onkonetwork system and that their questions had been fully addressed. Patients also granted permission for all data and results recorded or generated during their treatment—including those entered into or produced within the Onkonetwork system—to be used by the Moritz Kaposi General Hospital in Somogy County for scientific, research, and educational purposes. Consent for publication: NOT APPLICABLE Availability of data and materials: Data supporting the findings of this study are available from the authors upon reasonable request and with permission from the Moritz Kaposi General Hospital. Competing interests: The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding: This research did not receive funding. Authors' contributions: Gabriella Szörényiné Ványi conceived and coordinated the study, contributed to data collection, and drafted the manuscript. Annamária Szigeti managed patient pathway data within the OnkoNetwork and assisted in manuscript preparation. Zita Battyáni provided dermatological expertise, contributed to data interpretation, and critically revised the manuscript. Imre Repa supervised the study, supported methodological design, and provided critical intellectual input. All authors read and approved the final version of the manuscript. Acknowledgements: I wish to extend my sincere gratitude to the Head of the Department of Dermatology and the colleagues of the department for their invaluable support during the clinical practice in the care of patients with melanoma. I am also indebted to the staff of the OnkoNetwork Office for their assistance in the collection of data, which was essential for the completion of this work. Furthermore, I gratefully acknowledge the colleagues at the Office of Prevention and Health Promotion for their continuous help, patience, and encouragement throughout the course of this study. Finally, I express my profound appreciation to my co-authors and my supervisor for their dedicated efforts, guidance, and perseverance, which greatly contributed to the realization of this publication. Authors' information: Gabriella Szörényiné Ványi, MSc in Nursing and Health Management, leader of the Prevention and Health Promotion Office of the Hungarian Moritz Kaposi General Hospital in Somogy County since 2008. Developer and founder of the professional program of the first hospital health promotion office in Hungary. She has been working in the health care sector for more than 30 years and has been working at Moritz Kaposi General Hospital for 25 years. One of the developers and professional leaders of the "Healthy Kaposvár 2030" town program. In recognition of her work, she received the Pro Sanitate Award, a national award in 2020. Hungarian representative of the International Network of Health Promoting Hospitals & Health Services, founder and co-leader of the Task Force HPH Well-being of Healthcare Workers. Currently she is a PhD student at the University of Debrecen, School of Health Sciences. References Waseh S, Lee JB. 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Second primary melanomas in a cohort of 977 melanoma patients within the first 5 years of monitoring. Journal of the American Academy of Dermatology [Internet]. 2020 Feb;82(2):398–406. Available from: https://pubmed.ncbi.nlm.nih.gov/31499156/ doi:10.1016/j.jaad.2019.08.074 Ungureanu L, Zboraș I, Vasilovici A, Vesa Ș, Cosgarea I, Cosgarea R, et al. Multiple primary melanomas: Our experience. Experimental and Therapeutic Medicine. 2020 Nov 26;21(1). doi: 10.3892/etm.2020.9520 Moizs M, Király G, Repa I. OnkoNetwork – Az onkológiai betegútszervezés új magyar modellje [article in Hungarian]. Orvostovábbképző Szemle 2016; April Special issue: The current situation of oncological care:46–50. Moizs M, Ruzsa Á, Repa I, Csellik Z, Völgyi Z, Király G. Onkológiai betegút menedzselés gyakorlati megvalósítása [article in Hungarian]. Interdiszciplináris Magyar Egészségügy. 2015;14(6):50–4. Lukács M, Tóth T, Cselik Zs, Bajzik G, Toller G, Ruzsa Á, Moizs M, Repa I, Kovács Á. Daganatos betegek komplex, intézményi ellátásának ONKONETWORK által támogatott új rendszere, az ellátás hatékonyságának növelése céljából. [article in Hungarian]. KLINIKAI ONKOLÓGIA 2016; 3: Klsz Paper: 017, p: 1. Pitter JG, Csanádi M, Szigeti A, Lukács G, Kovács Á, Moizs M, et al. Planning, implementation and operation of a personalized patient management system for subjects with first suspect of cancer (OnkoNetwork): system description based on a qualitative study. BMC Health Services Research. 2019 Feb 21;19(1). doi: 10.1186/s12913-019-3957-9. Hajdarevic S, Hörnsten Å, Sundbom E, Isaksson U, Schmitt-Egenolf M. Health-Care Delay in Malignant Melanoma: Various Pathways to Diagnosis and Treatment. Dermatology Research and Practice. 2014;2014:1–6. doi: 10.1155/2014/294287. Cutaneous melanoma clinical quality performance indicators: January 2022 – Healthcare Improvement Scotland [Internet]. Healthcareimprovementscotland.scot. 2022 [cited 2024 Jul 30.]. Available from: https://www.healthcareimprovementscotland.scot/publications/cutaneous-melanoma-clinical-quality-performance-indicators-january-2022/ Wouters MW, Michielin O, Bastiaannet E, Beishon M, Catalano O, del Marmol V, et al. ECCO essential requirements for quality cancer care: Melanoma. Critical Reviews in Oncology/Hematology. 2018 Feb; 122:164–78., doi: 10.1016/j.critrevonc.2017.12.020. Zaadoud B, Chbab Y. Measuring Performance Quality in Health Care: Relevance and Validity of the Frameworks [Internet]. Enhancing Primary Care Delivery [Working Title]. IntechOpen; 2025. Available from: http://dx.doi.org/10.5772/intechopen.1011722 Tables Table 1: Phases of care for melanoma patients in the OnkoNetwork system Phases Events/steps Event/step description OnkoNetwork registration 1. Dermatological examination Patient presentation at the Dermatology Department of the Hospital 2. Clinically suspected melanoma Initial medical assessment, confirmation of suspicion, referral for primary excision Testing phase 3. Excisio Primary excision (specific to: Dermatology, Otolaryngology, Oral surgery, Surgery, Plastic surgery) 4. Histopathological diagnosis The result of the first histopathological diagnosis 5. Stage definition Second medical evaluation, staging, staging tests if necessary (referrals, appointments) 6. Staging studies Performing staging tests, preparing the case for Oncoteam Onkoteam phase 7. Onkoteam decision Oncoteam meeting, decision on wide excision, sentinel lymph node scan, block dissection, further investigations (PET CT, BRAF mutation scan), therapy, observation or referral Therapeutic phase 8. Starting therapy Start therapy if necessary Tracking phase 9. Dermato-oncological care Protocol follow-up, dermato-oncological care, observation Case closure 10. Closing of the case Final closure of the case Table 2: Phase distribution of melanoma patients in the OnkoNetwork system Phase All Active Suspended Closed Investigation 170 (25,37%) 25 9 136 Oncoteam 24 (3,58%) 2 3 19 Therapeutic 77 (11,49%) 16 10 51 Tracking 399 (59,55%) 306 23 70 in total: 670 349(52,09%) 45 (6,72%) 276 (41,19%) Table 3: QPI Indicator 4: Duration of time to confirm melanoma diagnosis with histopathological results within 1 month within 2 months within 3 months More than 3 months Total* within 21 days 22-31 32-60 61-90 >90 days 256 170 47 28 7 4 66,41%** 18,36%** 10,94% 2,73% 1,56% *Excluded from the assessment of QPI.3: Patients previously treated for melanoma. Those arriving from outside, with fabrics brought from elsewhere. Those who had not undergone excision for suspected melanoma (D030) but were diagnosed with other skin lesions were excluded. They were admitted to OnkoNetwork with a confirmed diagnosis of melanoma. Patients whose onset was on the same day as the confirmed diagnosis. "0" days is the difference. The patients had previously undergone surgery and were sent to a dermatologist with histopathology results. (It was not previously part of the protocol to have a suspicious lesion examined by a dermatologist before surgical removal. Since the European Consensus, it is mandatory.) ** 84.77% of patients admitted with suspected melanoma were diagnosed within one month. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Mar, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers invited by journal 26 Jan, 2026 Editor assigned by journal 03 Jan, 2026 Editor invited by journal 30 Dec, 2025 Submission checks completed at journal 30 Dec, 2025 First submitted to journal 30 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8403736","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581387809,"identity":"f0dd0bc5-fe61-4d10-a344-d823746bdd7d","order_by":0,"name":"Gabriella Szörényiné Ványi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYLCCDwwMPHwSEDYPwwEeBmZCOhhnAFWykaSFmQdIwLQwENQi33/G+LVtjp0Mm3TzMQnGtjsyfMd7DzAXtuHWYnDgjJl17rZkHjaZY8kGjG3PeCTPnEtgnolPC2NbmnHuNmagX3IMHzC2HeYxuJFjwMyLR4t8M1uaseW2epAWgwNgLfff4NfCcIz58GPGbYeRbeHBr8XgDPMxxt5txyF+STh3GOiXvITDPOfwOKz/YPOHn9uq7flBIfah7LA93/GzBx/zlOFxGHKMMCRA6QN4NQBj8gMBBaNgFIyCUTDSAQBAnUrMcXkWlQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Debrecen","correspondingAuthor":true,"prefix":"","firstName":"Gabriella","middleName":"Szörényiné","lastName":"Ványi","suffix":""},{"id":581387810,"identity":"664bd21d-aadb-4219-a98a-2833dc0b7bbf","order_by":1,"name":"Annamária Szigeti","email":"","orcid":"","institution":"Somogy Megyei Kaposi Mór Oktató Kórház","correspondingAuthor":false,"prefix":"","firstName":"Annamária","middleName":"","lastName":"Szigeti","suffix":""},{"id":581387811,"identity":"8dd59e55-cd11-4bc3-b9fd-d0458b9e1729","order_by":2,"name":"Zita Battyáni","email":"","orcid":"","institution":"Somogy Megyei Kaposi Mór Oktató Kórház","correspondingAuthor":false,"prefix":"","firstName":"Zita","middleName":"","lastName":"Battyáni","suffix":""},{"id":581387812,"identity":"3f133369-99bd-4ad5-9e3e-08c00454e144","order_by":3,"name":"Imre Repa","email":"","orcid":"","institution":"University of Debrecen","correspondingAuthor":false,"prefix":"","firstName":"Imre","middleName":"","lastName":"Repa","suffix":""}],"badges":[],"createdAt":"2025-12-19 10:38:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8403736/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8403736/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101436089,"identity":"4349fa8b-9e2f-4a86-b862-fb43e81c5d16","added_by":"auto","created_at":"2026-01-29 16:21:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14078,"visible":true,"origin":"","legend":"\u003cp\u003eOnkoNetwork patient pathway in the OnkoNetwork system\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8403736/v1/f8399047545e8b5d3d714ffc.png"},{"id":101436088,"identity":"d3f9ae0d-7933-4d77-9a1b-c28686ee3547","added_by":"auto","created_at":"2026-01-29 16:21:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":218931,"visible":true,"origin":"","legend":"\u003cp\u003eOncology pathway management for melanoma patients in OnkoNetwork\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8403736/v1/1795f8e451c86058bfd70e39.png"},{"id":101751653,"identity":"09c404cc-79d1-4a13-a4dc-ea1120e7f7be","added_by":"auto","created_at":"2026-02-03 10:22:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":948591,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8403736/v1/238ad97c-8b4d-4609-90a1-43d9362d550a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optimizing time and care coordination for melanoma patients in the Onkonetwork system","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cstrong\u003eEpidemiology and significance of melanoma\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe steep increase in the incidence of melanoma makes oncology patient pathway management for melanoma patients a priority. Over the past two decades, the incidence and mortality of melanoma have doubled, especially in countries with light-skinned populations of European descent. (1, 2) In the United States, a threefold increase in incidence has been observed. (3) Compared with that of any other malignancy, the\u0026nbsp;incidence of melanoma is increasing faster in both sexes, except in women,\u0026nbsp;where the increase is primarily due to lung cancer.\u0026nbsp;(4)\u0026nbsp;GLOBOCAN estimated incidence and mortality data show that in 2022, melanoma was the 17th most common malignancy worldwide,\u0026nbsp;with 331,647 cases per year. In terms of mortality, it was the 22nd-ranked malignancy,\u0026nbsp;with 58,645 cases per year. In Hungary, melanoma was the 11th most common malignancy in 2022 (5, 6, 7, 8).\u003c/p\u003e\n\u003cp\u003eAccording to the data of the National Cancer Registry, in line with international trends, the incidence of melanoma in Hungary is increasing dramatically, with the number of new cases doubling in the last two decades, reaching nearly 3,000 per year. Melanoma causes 300\u0026ndash;400 deaths per year in Hungary. (9) A Hungarian real-world retrospective analysis of melanoma management (RAMM) confirmed this finding, revealing a significant reduction in mortality in the overall melanoma population. (10) The MIR of melanoma in Hungary is the lowest in Central and Eastern Europe and comparable to that of Western and Northern European countries. (11)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMelanoma care guidelines and issues\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA European consensus-based interdisciplinary guideline on the care of patients with melanoma details the guidelines for the diagnosis of melanoma, including time management of follow-up and care. (12) The consensus also sets out treatment guidelines (13), which are followed by national surgical standards. A dermatologist should examine the suspected lesion, which should then be surgically removed as soon as possible (within 2\u0026ndash;4 weeks) with an intact zone of 1\u0026ndash;3 mm (14).\u003c/p\u003e\n\u003cp\u003eThe guidelines and standards of care for patients with melanoma in Europe and at home are therefore well defined, evidence-based and consensus-based. Domestic studies have shown that the main problem for oncology patients is not the quality of treatment. For patients, one of the greatest problems is the time from suspicion to diagnosis and the organization and coordination of examinations and appointments. (15) Patients feel \u0026apos;lost\u0026apos;, left to their own devices in the system. They suffer from a lack of information, do not know what will happen to them and when, and lack a detailed treatment plan. (16) This was confirmed by a comprehensive, systematic, international review of the unmet needs of cancer patients. Researchers have concluded that the second greatest problem for cancer patients, after psychological/emotional support, is access to the health care system/information (17).\u003c/p\u003e\n\u003cp\u003eSeveral international studies have shown that oncology care and patient pathway organization increase the chances of appropriate healthcare, shorten waiting times, improve access, and facilitate capacity management, thus increasing patient safety and patients\u0026apos; chances of recovery. On the basis of the results of a meta-analysis by S.S. Gorin and colleagues, the coordination of oncology care resulted in 81% improvements in outcomes, from screening to treatment to the quality of end-of-life care (18).\u003c/p\u003e\n\u003cp\u003eFor patients with melanoma, not only early detection and treatment but also care and follow-up are important, as individuals with a history of melanoma are at risk of developing metastases and subsequent melanoma recurrence. (19, 20, 21, 22) Therefore, patient-centred, integrated oncology care is of paramount importance for patients with melanoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground of the OnkoNetwork oncology patient pathway management system\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe development and establishment of the OnkoNetwork, an oncology patient pathway management system, represents a paradigm shift in Hungarian oncology care. There are similar case management systems in international practice, but the Kaposv\u0026aacute;r model is the first in Hungary. (23) The essence of the OnkoNetwork is single, comprehensive, integrated oncology care based on a protocol system. The main objective is to ensure that patients with a suspected oncological diagnosis are not lost in the care system and receive diagnosis and treatment within a given time, with priority in the system of the institution, ensuring early diagnosis and curative therapy. Long-term goals included the development of a valid, prospectively collected oncology database that would allow for a real analysis of morbidity and mortality, as well as the involvement of cancer screening and the primary care system. The OnkoNetwork office, which is the hub of networking, was established with human and financial resources.\u0026nbsp;Innovative professional roles have been introduced for\u0026nbsp;nonphysicians\u0026nbsp;and physicians (24, 25, 26).\u003c/p\u003e\n\u003cp\u003eThree basic time-related indicators are defined, which represent the optimal expected time (Figure 1).\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe patient should be diagnosed within 21 days of disease onset (with suspected institutional melanoma).\u003c/li\u003e\n \u003cli\u003eOnkoTeam must make a decision on the patient within 30 days of the start of the case.\u003c/li\u003e\n \u003cli\u003eTreatment should start within 14 days of the OnkoTeam decision.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe increase in the number of publications on melanoma is far behind the dramatic increase in the number of melanoma patients (4), making this topic of paramount importance.\u003c/p\u003e\n\u003cp\u003eThis publication presents and critically examines the oncology patient pathway management system applied in the care of melanoma patients. The authors aim to introduce an innovative framework and provide a practical, evidence-based example of integrative oncology care in the context of melanoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study analysed the oncological care pathways of 670 patients diagnosed with malignant melanoma (ICD-10: C43) and melanoma in situ (ICD-10: D030) and treated at Moritz Kaposi General Hospital and within the OnkoNetwork system between 1 October 2015 and 31 December 2023. The data sources included the e-MedSolution hospital IT system and OnkoLogistic software (Trademark registration number M1601197/4). During the development process, OnkoLogistic was replaced by the OnkoNetwork system, which was integrated as a medical module within e-MedSolution. Background data and the phases of the oncology patient pathway management system were analysed via descriptive statistical methods. \u003cstrong\u003eStudy cohort:\u0026nbsp;\u003c/strong\u003eA total of 670 patients with malignant melanoma (ICD-10: C43) or melanoma in situ (ICD-10: D030) were enrolled in the OnkoNetwork during the study period. Among these, 52% (n=350) were female, and 48% (n=320) were male. The majority of patients were aged 60\u0026ndash;79 years. Among the histological subtypes, 54% were superficial spreading melanomas, 19% were nodular melanomas, 11% were lentigo maligna melanomas, 2% were acral lentiginous melanomas, and 14% were other melanoma types. The tumor thickness distribution revealed 19% in situ melanomas, 35% thin (\u0026lt;1 mm), 27% intermediate (1\u0026ndash;4 mm), and 15% thick (\u0026gt;4 mm). The most common stage was IA (28.51%), followed by Stage 0 (20.9%), IB (11.94%), IIB (10.35%), IIA (8.06%), IV (8.06%), III (6.87%), and IIC (5.07%).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFour phases have been identified in the process: investigational, oncological, therapeutic and follow-up. Table 1 shows the phases and events in the care of melanoma patients. The status of the phases was examined according to the status downloaded on 29 January 2024. Performance indicators and process indicators were defined for clinical quality assessment. The implementation of phases and time management were monitored and compared with the time limits required by the system. The care process from the first clinical suspicion to the closure of the case was analysed. Clinical quality indicators for melanoma from studies in northern Sweden (27) and Scotland (28) were used as examples for the evaluation. IBM SPSS Statistics 25.0 software was used for analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003ePhases of oncological care:\u0026nbsp;\u003c/strong\u003eOf the 670 patients diagnosed with melanoma, 170 patients (25.37%) were in the investigational phase, 24 (3.58%) were in the Oncoteam phase, 77 (11.49%) were in the therapeutic phase, and 399 (59.55%) were in the follow-up phase (Table 2). A total of 349 patients (52.09%) were in the active phase, 45 patients (6.72%) were in the suspended phase, and 276 patients (41.19%) were in the closed phase. Among the patients in the closed phase, 119 patients were permanently closed, 104 of whom were closed because of patient death.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eProcess Quality Performance Indicators (PQPIs):\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eQPI. 1. OnkoNetwork recording:\u0026nbsp;\u003c/strong\u003eRegistration of the patient in the OnkoNetwork system with a suspected or confirmed histological diagnosis of melanoma.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e100% met. A total of 41.49% of patients were admitted with suspected melanoma, and 58.51% had confirmed histological diagnoses. The confirmed histopathological diagnosis was an external diagnosis from another institution in 220 (32.83%) patients and a local histopathological diagnosis in 172 (25.67%) patients. Cases admitted with suspected melanoma (278 cases, 41.49%) were later confirmed by histopathology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQPI. 2. Pathology report:\u0026nbsp;\u003c/strong\u003ePercentage of patients with cutaneous melanoma who underwent diagnostic excision (excision) and confirmed a melanoma diagnosis via histology.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e100% met. A total of 32.83% (220) of patients with melanoma presented with histology results, and 67.16% (450) had local institutional histology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQPI. 3. Every oncology patient should have their own oncology doctor:\u0026nbsp;\u003c/strong\u003e100% met.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQPI.4. Investigation and diagnosis\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ewere performed\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ewithin 21 days of the start of the case\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIn 66.41% of patients admitted with suspected melanoma, the diagnosis of melanoma was confirmed by histology within 21 days. A total of 84.77% of patients received a confirmed diagnosis within one month. Table 3\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQPI. 5. Oncoteam decision within 30 days of the start of the case:\u0026nbsp;\u003c/strong\u003eOut of 670 melanoma patients, a total of 513 (76.56%) had their first Oncoteam session at the Institute. A total of 102 cases required a 2nd Oncoteam session, 24 cases required 3, 10 cases required 4, and 1 case required 5 Oncoteam sessions. Among the 513 Oncoteam meetings, 227 cases (44.24%) were held within 30 days of the start of the case. A further 169 patients were selected within 60 days.\u003c/p\u003e\n\u003cp\u003eThere was no oncological meeting at the institution for the following cases: 126 in situ melanoma cases (18.8%). In 15 cases, the patient was referred to another institution for Oncoteam (2.2%), and 16 cases without Oncoteam were included in the reference period (2.3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQPI.6.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTherapy was started\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;within 14 days of the first Onkoteam decision:\u0026nbsp;\u003c/strong\u003e339 patients were reexcised. Among these patients, 113 patients started oncological care after reexcision. A total of 226 patients underwent reexcision in combination with sentinel lymph node scan and/or block dissection. In 219 patients, no other intervention was needed, so oncological care was started. In 9 other cases, radical surgical treatment was performed (3 of which were amputations), and sentinel lymph node examination and/or block dissection were performed. In 25 patients, other therapies were ordered after excision (radiotherapy, interferon, PD-1 treatment, treatment of metastases, etc.), and further investigations were ordered in 25 patients. Forty-six patients were referred to another institution (Melanoma Centre) for further care. A total of 7 patients did not receive further oncological care (the patient did not return, was not fit for further treatment or was referred to hospice care). If additional therapy was ordered, the therapeutic phase started immediately after the Oncoteam decision was reached.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQPI. 7. Tracking:\u0026nbsp;\u003c/strong\u003eAt the time of the study, 59.55% of the 670 patients were in the follow-up phase. Of these, 399 were actively followed up, 23 were suspended, and 70 were closed. During oncodermatological care and observation, 55 patients (8%) developed new melanoma, and 18 patients (3%) developed subsequent metastasis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn Hungary, the diagnosis and treatment of melanoma patients essentially starts with specialist dermatology services.\u003c/p\u003e\n\u003cp\u003eThe basic route is as follows:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eSuspicious lesion detection (patient, GP, occasional screening programmes, other specialist care, etc.).\u003c/li\u003e\n \u003cli\u003eIf a suspicious lesion is found, a dermatologist should be consulted to confirm the suspicion of melanoma and/or recommend removal of the suspicious lesion for differential diagnosis. Without a dermatological examination and recommendation, removal of the suspicious lesion would not be possible today.\u003c/li\u003e\n \u003cli\u003eDepending on the location, size and shape of the suspected lesion, it may be removed (excision) by a dermatologist, surgeon, plastic surgeon, oral surgeon, ear, nose and throat specialist or a specialist surgeon in the area concerned. According to professional protocols, punch incisional biopsy can be performed only if the tumor is large and difficult to remove or if the anatomy does not allow excision. Otherwise, punch incisional biopsy of the melanoma is prohibited.\u003c/li\u003e\n \u003cli\u003eHistological examination of all removed samples is mandatory.\u003c/li\u003e\n \u003cli\u003eThe results of the histopathology examination are sent to the submitting dermatologist or surgeon, the patient can see them in the electronic health service space, and the patient\u0026apos;s GP can also view them.\u003c/li\u003e\n \u003cli\u003eWith the histopathology result, the patient should return to the dermatologist, who will order the next steps according to the protocol. Depending on the histopathology, oncological or further treatment, for example, reexcision with specific margins, excision with sentinel lymph node scan/bloc dissection, radical surgery, or initiation of oncodermatological care.\u003c/li\u003e\n \u003cli\u003eCare and tracing are then carried out according to the protocol and the decision of the Oncoteam.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe care and chances of patients with melanoma depend largely on when they enter the care system, when and where they are seen by a dermatologist, and when the suspected lesion is removed.\u003c/p\u003e\n\u003cp\u003eThe OnkoNetwork system is a unique way to support integrated oncology care for all cancer patients. It currently manages the active oncology care of 13,484 out of 12,487 patients. The system provides the possibility to access detailed information on individual cancers and to evaluate the progress of care, even by type of cancer. This provided the opportunity for a system-wide analysis of the care of 670 melanoma patients.\u003c/p\u003e\n\u003cp\u003eThe results confirm that the management of the oncological pathway of melanoma patients is a highly complex and multifaceted process. However, owing to the system, the phases of care, events, turnaround times, tasks and roles are well controlled and traceable (Figure 2).\u003c/p\u003e\n\u003cp\u003eAs this was the first and for a long time the only oncology patient pathway management system and no such studies or publications have been performed or are available in Hungary, we cannot compare our results with data from other institutions. In this study, we conducted a self-assessment of the process and an evaluation of the quality indicators we established.\u003c/p\u003e\n\u003cp\u003eThe first three quality indicators (QPIs 1, 2, and 3) were met in all patients with melanoma. Thus, all melanoma patients with suspected or diagnosed melanoma are enrolled in the Onko Network at first hospital admission or within 24 hours of admission. This is ensured by the system\u0026apos;s automatic notifications, alerts and the OnkoNetwork office staff. A diagnosis of melanoma can be confirmed only by a histopathology result; therefore, all patients with melanoma have a histopathology result. All patients with melanoma have an oncology doctor, as the care of melanoma patients at our hospital is provided by dermatologists who are also board certified in oncology.\u003c/p\u003e\n\u003cp\u003eWe found differences in the process and timing of care, depending on whether the patient came to the hospital with an external suspicion or diagnosis or whether their care started in the hospital. On average, the time between the date of external suspicion and diagnosis (QPI.4: have a histological diagnosis within 21 days) was two to three times longer than in cases where the initial care (screening or examination of the suspicious lesion) started in the hospital. For those presenting with an external suspicion or an external histopathology, it was therefore not possible to assess the time interval between the discovery of the case and the histopathology. For the patients included in the analysis, 66.41% of patients reached diagnosis within 21 calendar days. The rate is more favourable when the expected 21-day time frame is supplemented by a minimum tolerance period (taking into account that holidays and weekends are included in the 21 calendar days). When a 1-month time interval is considered, nearly 90% of patients reach a histopathology-confirmed diagnosis of melanoma.\u003c/p\u003e\n\u003cp\u003eFor the second indicator, the time to make an Onokteam decision within 30 days of the start of the case (QPI 5), the 30-day deadline was met in nearly half of the cases. The majority of patients for whom an Onkoteam decision was made after 30 days were stage IA patients. We found that the reasons for Onkoteam decisions beyond 30 days included delays in the date of reexcisio and the implementation of further investigations, especially during the COVID-19 epidemic.\u003c/p\u003e\n\u003cp\u003eFor histologically confirmed in situ melanomas, the protocol allows the Oncoteam session to be waived if the excision is of sufficient width and depth. In most of these cases, excision is in itself a therapy. For this reason, among others, the use of the QPI indicator 6 to start therapy within 14 days of the Oncoteam decision is again a nuanced assessment for patients with melanoma. In 32.68% of patients, no further oncological intervention was required after the first excision, in which case follow-up and oncological care were started. Half of the patients also did not require further oncological intervention after reexcision (with or without sentinel lymph node scan). Overall, 83.28% of patients did not require any further therapy other than surgery. For the remaining patients, the therapeutic phase started immediately after the Oncoteam decision, including if the patient was referred to another institution.\u003c/p\u003e\n\u003cp\u003eThe last of the process indicators is the assessment of follow-up (QPI 7). At the time of the survey, nearly 60% of the patients were already in the follow-up phase. In Hungary, the follow-up and oncodermatological care of melanoma patients is provided entirely by specialized care (hospital dermatology). However, the involvement of general practitioners is very important in reaching and tracing patients if they do not attend their prescribed examinations. During the follow-up, 55 patients developed new melanoma, and 18 patients developed subsequent metastasis during the period under review, which highlights the importance of an integrated oncology care management system.\u003c/p\u003e\n\u003cp\u003eThe introduction of a uniform oncology patient pathway management system would be a prerequisite for a nationwide, comprehensive quality assessment of oncology care for melanoma patients. For the evaluation of the system, uniform criteria and quality indicators should be defined, similar to the basic requirements of the ECCO (European CanCer Organization) for access to quality cancer care (29).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe OnkoNetwork network builds on the traditional oncology care system, clearly improving its functioning and organization and directly supporting and treating each patient. Notably, OnkoNetwork is a process management system and database integrated into the day-to-day running of hospitals. The advantage of this approach is that no patient admitted with suspected melanoma is lost in the course of care, thus significantly reducing the critical time delay from suspicion to histological diagnosis in melanoma patients. It also has the advantages of prioritizing the critical points of oncology patient care, entry into the system, clinical trials and follow-up. The OnkoNetwork system not only facilitates early treatment but also provides consistent oncological care for all patients, including those with melanoma or other malignant skin tumours.\u003c/p\u003e \u003cp\u003eOur study provides a stopgap, practical example of how the system works and what data it can store and act as a \"register\". Each step is traceable, and the system's automatic alerts help ensure that the defined phases, tests, interventions and time indicators are achieved. According to the system, 66.41% of melanoma patients receive a diagnosis within 21 calendar days, and almost 90% receive a diagnosis within one month. The Onkoteam decision is made within 30 days for nearly half of patients, and if therapy other than surgery is ordered, the therapeutic phase starts immediately after the Onkoteam decision.\u003c/p\u003e \u003cp\u003eIn addition to encouraging results, continuous improvement, monitoring and training of professionals working in the system is essential. Our study highlights the need to place greater emphasis on collaboration with GPs in the early detection of melanoma, accelerating vertical patient pathways. For those presenting with an external suspicion, efforts should be made to establish a diagnosis within 21 days and to implement an Oncoteam decision within 30 days.\u003c/p\u003e \u003cp\u003e This is the first publication in Hungary to analyse and present the oncology care pathway for patients with melanoma. This study provides a good example of how an oncology patient pathway management system can facilitate the follow-up of melanoma patients for up to 10 years or for life.\u003c/p\u003e \u003cp\u003eThe greatest benefit\u0026mdash;clearly\u0026mdash;is for the patient, who is \"held by the hand\" throughout care and treatment. It is not lost in the system if your doctor changes, nor if you forget when you need to go for a check-up. Another benefit for patients is that they are assured of consistent quality, protocol-based care that all patients receive equally.\u003c/p\u003e \u003cp\u003eAt the same time, it has also been extremely useful for doctors, who have had to care for hundreds of patients with melanoma over the years and decades. For their part and for specialist care, such a support system is essential to ensure that all their patients are properly cared for.\u003c/p\u003e \u003cp\u003eThe system also provides the hospital with a particular economic and operational advantage, as it makes it possible to review, monitor, plan and control the examination and care of oncology patients.\u003c/p\u003e \u003cp\u003eThe use of the Onkonetwork system in other hospitals would be a potentially useful tool for evaluating the performance and quality of care provided to patients treated for melanoma or any other type of cancer. Quality performance indicators (QPIs) in healthcare increase patient safety and outcomes, improve care quality, increase transparency and accountability, improve operational efficiency, support financial health, inform policy and management, and enable benchmarking and learning. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThis study has several limitations. This study was conducted at a single institution, which may limit generalizability. The observational design without a control group restricts causal interpretation. The analysis focused mainly on process indicators rather than long-term outcomes such as survival or quality of life. The patient cohort, while sizeable, may not represent all melanoma cases. Finally, standardized protocols, although ensuring consistency, may reduce flexibility for atypical or complex cases.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eThe research was carried out with the permission of the Moritz Kaposi General Hospital Institutional Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations:\u003c/strong\u003e All procedures involving human participants were conducted in accordance with institutional and national ethical standards\u0026nbsp;and fully complied with the principles of the Declaration of Helsinki. Participation in Onkonetwork‑supported care pathways required written informed consent. Patients provided their consent through individual consent forms, acknowledging that they had received adequate information about the purpose and operation of the Onkonetwork system and that their questions had been fully addressed.\u003c/p\u003e\n\u003cp\u003ePatients also granted permission for all data and results recorded or generated during their treatment\u0026mdash;including those entered into or produced within the Onkonetwork system\u0026mdash;to be used by the Moritz Kaposi General Hospital in Somogy County for scientific, research, and educational purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNOT APPLICABLE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData supporting the findings of this study are available from the authors upon reasonable request and with permission from the Moritz Kaposi General Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research did not receive funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e Gabriella Sz\u0026ouml;r\u0026eacute;nyin\u0026eacute; V\u0026aacute;nyi conceived and coordinated the study, contributed to data collection, and drafted the manuscript. Annam\u0026aacute;ria Szigeti managed patient pathway data within the OnkoNetwork and assisted in manuscript preparation. Zita Batty\u0026aacute;ni provided dermatological expertise, contributed to data interpretation, and critically revised the manuscript. Imre Repa supervised the study, supported methodological design, and provided critical intellectual input. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eI wish to extend my sincere gratitude to the Head of the Department of Dermatology and the colleagues of the department for their invaluable support during the clinical practice in the care of patients with melanoma. I am also indebted to the staff of the OnkoNetwork Office for their assistance in the collection of data, which was essential for the completion of this work. Furthermore, I gratefully acknowledge the colleagues at the Office of Prevention and Health Promotion for their continuous help, patience, and encouragement throughout the course of this study. Finally, I express my profound appreciation to my co-authors and my supervisor for their dedicated efforts, guidance, and perseverance, which greatly contributed to the realization of this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information:\u0026nbsp;\u003c/strong\u003eGabriella Sz\u0026ouml;r\u0026eacute;nyin\u0026eacute; V\u0026aacute;nyi, MSc in Nursing and Health Management, leader of the Prevention and Health Promotion Office of the Hungarian Moritz Kaposi General Hospital in Somogy County since 2008. Developer and founder of the professional program of the first hospital health promotion office in Hungary. She has been working in the health care sector for more than 30 years and has been working at Moritz Kaposi General Hospital for 25 years. One of the developers and professional leaders of the \u0026quot;Healthy Kaposv\u0026aacute;r 2030\u0026quot; town program. In recognition of her work, she received the Pro Sanitate Award, a national award in 2020. Hungarian representative of the International Network of Health Promoting Hospitals \u0026amp; Health Services, founder and co-leader of the Task Force HPH Well-being of Healthcare Workers. Currently she is a PhD student at the University of Debrecen, School of Health Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWaseh S, Lee JB. Advances in melanoma: epidemiology, diagnosis, and prognosis. Frontiers in Medicine. 2023 Nov 22;10. doi: 10.3389/fmed.2023.1268479\u003c/li\u003e\n\u003cli\u003eArnold M, Singh D, Laversanne M, Vignat J, Vaccarella S, Meheus F, et al. Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040. 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Health-Care Delay in Malignant Melanoma: Various Pathways to Diagnosis and Treatment. Dermatology Research and Practice. 2014;2014:1\u0026ndash;6. doi: 10.1155/2014/294287.\u003c/li\u003e\n\u003cli\u003eCutaneous melanoma clinical quality performance indicators: January 2022 \u0026ndash; Healthcare Improvement Scotland [Internet]. Healthcareimprovementscotland.scot. 2022 [cited 2024 Jul 30.]. Available from: https://www.healthcareimprovementscotland.scot/publications/cutaneous-melanoma-clinical-quality-performance-indicators-january-2022/ \u003c/li\u003e\n\u003cli\u003eWouters MW, Michielin O, Bastiaannet E, Beishon M, Catalano O, del Marmol V, et al. ECCO essential requirements for quality cancer care: Melanoma. Critical Reviews in Oncology/Hematology. 2018 Feb; 122:164\u0026ndash;78., doi: 10.1016/j.critrevonc.2017.12.020.\u003c/li\u003e\n\u003cli\u003eZaadoud B, Chbab Y. Measuring Performance Quality in Health Care: Relevance and Validity of the Frameworks [Internet]. Enhancing Primary Care Delivery [Working Title]. IntechOpen; 2025. Available from: http://dx.doi.org/10.5772/intechopen.1011722\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Phases of care for melanoma patients in the OnkoNetwork system\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvents/steps\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvent/step description\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003eOnkoNetwork registration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e1. Dermatological examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003ePatient presentation at the Dermatology Department of the Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e2. Clinically suspected melanoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eInitial medical assessment, confirmation of suspicion, referral for primary excision\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 21px;\"\u003e\n \u003cp\u003eTesting phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e3. Excisio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003ePrimary excision (specific to: Dermatology, Otolaryngology, Oral surgery, Surgery, Plastic surgery)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e4. Histopathological diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eThe result of the first histopathological diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e5. Stage definition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eSecond medical evaluation, staging, staging tests if necessary (referrals, appointments)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e6. Staging studies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003ePerforming staging tests, preparing the case for Oncoteam\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eOnkoteam phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e7. Onkoteam decision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eOncoteam meeting, decision on wide excision, sentinel lymph node scan, block dissection, further investigations (PET CT, BRAF mutation scan), therapy, observation or referral\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eTherapeutic phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e8. Starting therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eStart therapy if necessary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eTracking phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e9. Dermato-oncological care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eProtocol follow-up, dermato-oncological care, observation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eCase closure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e10. Closing of the case\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eFinal closure of the case\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Phase distribution of melanoma patients in the OnkoNetwork system\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuspended\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClosed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInvestigation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e170 (25,37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOncoteam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e24 (3,58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTherapeutic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e77 (11,49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTracking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e399 (59,55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cem\u003ein total:\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e349(52,09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e45 (6,72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e276 (41,19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3: QPI Indicator 4: Duration of time to confirm melanoma diagnosis with histopathological results\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"611\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003ewithin 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003ewithin 2 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003ewithin 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eMore than 3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003eTotal*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003ewithin 21 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e22-31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e32-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e61-90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026gt;90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e66,41%**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e18,36%**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10,94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2,73%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1,56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;*Excluded from the assessment of QPI.3:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003ePatients previously treated for melanoma.\u003c/li\u003e\n \u003cli\u003eThose arriving from outside, with fabrics brought from elsewhere.\u003c/li\u003e\n \u003cli\u003eThose who had not undergone excision for suspected melanoma (D030) but were diagnosed with other skin lesions were excluded. They were admitted to OnkoNetwork with a confirmed diagnosis of melanoma.\u003c/li\u003e\n \u003cli\u003ePatients whose onset was on the same day as the confirmed diagnosis. \u0026quot;0\u0026quot; days is the difference. The patients had previously undergone surgery and were sent to a dermatologist with histopathology results. (It was not previously part of the protocol to have a suspicious lesion examined by a dermatologist before surgical removal. Since the European Consensus, it is mandatory.)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e**\u003c/strong\u003e 84.77% of patients admitted with suspected melanoma were diagnosed within one month.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"integrated oncology care, melanoma, OnkoNetwork, oncology patient pathway management, patient-centred care, time management","lastPublishedDoi":"10.21203/rs.3.rs-8403736/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8403736/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe increase in melanoma incidence makes oncology patient pathway management for melanoma patients a priority. The aim of this publication is to present the oncological care of patients with melanoma in Hungary's first oncology patient pathway management system. The OnkoNetwork system was developed and implemented in 2015 in Moritz Kaposi General Hospital in Somogy County, where the authors followed the care of 670 patients with melanoma among thousands of oncology patients. The system monitored the process and time management of melanoma patients' care from the time of suspicion to the time of closure. The diagnosis, oncological treatment and follow-up of patients are governed by standardized protocols. The system ensures that patients are seen and diagnosed within 21 days. The Oncoteam, within 30 days of entering the system, decides on the patient's further investigation and treatment, and treatment starts within 14 days of the Oncoteam's decision. The importance of the OnkoNetwork system is, first and foremost, to provide uniform, protocol-driven care, redirect \"lost\" patients and reduce delays due to anomalies in the healthcare system. With the use of a patient pathway management system, the diagnosis, treatment and follow-up of melanoma patients are prioritized.\u003c/p\u003e","manuscriptTitle":"Optimizing time and care coordination for melanoma patients in the Onkonetwork system","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 16:21:18","doi":"10.21203/rs.3.rs-8403736/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-16T14:54:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291665779963524930469419041788835122913","date":"2026-02-24T16:00:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-26T17:02:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-03T13:55:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T09:58:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-30T08:24:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-12-30T08:16:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30038ef3-9d01-4386-b7fc-b1976f9cf938","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T16:21:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 16:21:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8403736","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8403736","identity":"rs-8403736","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}