UK guidelines recommend that management of melanoma includes initial excision biopsy (IEB) with a margin of 2-5mm, followed by wide local excision (WLE) - margins depending on Breslow thickness of the IEB.

Aims: 

To assess clinical indicators in melanoma management   1. Determine the suitability of margins of IEB & WLE   2. Assess the interval between the two procedures 

Method:

Thirty patients with cutaneous melanoma during a continuous 3 month period in 2008 were analysed. 

Results :

   - IEB margins appropriate 100% in hospital, but documentation available for only 25% of GP excisions.

   - WLE margins appropriate according to guidelines in 100% of cases (all performed in the hospital).

  - Average wait from IEB to WLE: 35 days when IEB was done in the hospital and 48 days when the IEB was performed in the community

Conclusion and Recommendations:

   - Excisions of Melanomas (IEB and WLE) by hospital specialists are currently meeting guidelines.

    - Melanomas excised in the community may not be receiving further treatment as rapidly as those excised by hospital specialists.

   - Primary care physicians need to be adequately trained in diagnostic skills, regularly audited and encouraged to adhere to NICE-guidelines.