The Deep End

Surgical trials in melanoma have focused strictly on the width of margins, but how deep should the excision go? Investigators recently addressed this question in a survey of dermatologists and melanoma specialists, including dermatologists, oncologists, and surgeons working in pigmented lesion clinics. The authors asked how deep the participants excised for melanomas of varying histologic thicknesses. In all, 115 specialists and 383 nonspecialist dermatologists responded.

Nonspecialist dermatologists had more patient visits than specialists; 58% reported more than 400 visits per month versus 16% of specialists. However, as might be expected, the specialists diagnosed more melanomas. The clinician groups did not differ significantly in excisi…