Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision.
BACKGROUND
The epidemiology of melanoma is changing and its current management is variable, with some lesions being removed in general practice. We aimed to determine the quality of excision and time to diagnosis relating to the excising surgeon and the place of excision.


METHODS
Analysis of data from the North Wales Melanoma Database.


RESULTS
In total, 578 cases were diagnosed 1993-2001. There was a gender difference with anatomical location, with 107 (65%) males with lesions on their trunk compared to 57 (35%) females. Median Breslow thickness was 1.10 mm (range 0.05-16.0 mm). Ninety-five (16%) lesions were removed in general practice, of which 49 (52%) were referred on to hospital. In total, 266 (61%) lesions were excised with 'adequate' margins and 170 (39%) excised with margins narrower than the guidelines. General practice excisions were from a younger group than hospital excisions. There were no differences in quality of excision between general practice and hospital excisions. Time to diagnosis was shorter overall for general practice excisions than hospital excisions (median 12 versus 41 days, P < 0.001).


CONCLUSIONS
These findings are of policy importance in that there is no evidence from this study that general practice excisions are managed poorly or have a worse prognosis.
Department of Primary Care and Public Health, North Wales Clinical School/School of Medicine, Cardiff University, Wrexham Technology Park, Wrexham LL137YP, UK. nealrd@cf.ac.uk
Richard D
RD
Neal
Rebecca
R
Cannings-John
Kerenza
K
Hood
Jonathan
J
Sowden
Helen
H
Lawrence
Claire
C
Jones
Julie
J
Jones
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012042:Registries; D013514:Surgical Procedures, Operative / Q000379:methods / Q000592:standards*; D014852:Wales / Q000453:epidemiology