title: A comparison of current practice patterns of US dermatologists versus published guidelines for the biopsy, initial management, and follow up of patients with primary cutaneous melanoma.
abstract: BACKGROUND
  Guidelines exist for the management of cutaneous malignant melanoma, but their adoption, prevalence, and impact have not yet been determined.
  
  
  OBJECTIVE
  To determine current melanoma clinical management practices of US dermatologists and the variance from guidelines that might exist.
  
  
  METHODS
  A cross-sectional e-mail survey study assessing preferred biopsy methods for lesions suspicious for melanoma, margins used for excision, and recommended follow-up intervals were sent to 6177 US dermatologists (540 responding). The representative nature of the responding subset was verified by comparing their demographics to that from the American Academy of Dermatology (AAD) membership.
  
  
  RESULTS
  Management varied from published guidelines. Shave biopsy (35%) was the most commonly used method followed by narrow excisional biopsy (31%), saucerization/scoop shave (12%), punch (11%), and wide excision (3%). Excisional margins narrower than recommended were noted and follow-up intervals varied. There were significant management differences noted for dermatologists by practice setting and by years in practice.
  
  
  CONCLUSIONS
  The impact of patient history, lesion anatomic site, and size of lesion were not assessed. Recall and nonresponder sampling bias may exist.
  
  
  CONCLUSIONS
  Variations in dermatologists' approaches to melanoma management and variance from current guidelines suggest that a knowledge gap may exist representing an educational opportunity. However, emerging data may also justify deviations from existing guidelines, suggesting a reassessment of the guidelines may be indicated.
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai and Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Farberg
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai and Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York. Electronic address: dsrigel@prodigy.net.
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Rigel
mesh_terms: D000359:Aftercare / Q000592:standards; D001706:Biopsy / Q000379:methods; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003880:Dermatology / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D000072662:Margins of Excision; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D011795:Surveys and Questionnaires; D014481:United States
keywords: biopsy; follow up; guidelines; melanoma; melanoma management; primary cutaneous melanoma; surgical margins