Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision

Fam Pract. 2008 Aug;25(4):221-7. doi: 10.1093/fampra/cmn036. Epub 2008 Jun 23.


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.

Method: 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).

Conclusion: 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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Disease-Free Survival
  • Family Practice / standards*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medical Oncology / standards*
  • Melanoma / epidemiology
  • Melanoma / pathology
  • Melanoma / surgery*
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Quality Assurance, Health Care
  • Registries
  • Surgical Procedures, Operative / methods
  • Surgical Procedures, Operative / standards*
  • Wales / epidemiology