MANAGEMENT OF CUTANEOUS MALIGNANT-MELANOMA BY DERMATOLOGISTS OF THE AMERICAN-ACADEMY-OF-DERMATOLOGY .2. DEFINITIVE SURGERY FOR MALIGNANT-MELANOMA

Background: During the past few decades there has been increasing interest and training in dermatologic surgery. Objective: Our purpose was to determine to what extent members of the American Academy of Dermatology (AAD) are involved in the surgical management of patients with malignant melanomas (MMs), comparing 1982 with 1992. Methods: Members of the AAD practicing in the United States (N = 7412) were sent a questionnaire that surveyed their role in the definitive treatment of patients with MMs and the surgical margins of normal-appearing skin that they used or recommended for melanomas of various thicknesses. Results: Sixty-four percent of the respondents stated that they performed the definitive surgery for in situ melanoma in 1992, a 14% increase from 1982. Although a significantly greater percentage of dermatologists were performing the definitive surgery for invasive melanoma in 1992 (28%) compared with 1982 (14%), the majority continued to refer their patients to surgical colleagues for definitive treatment. There has been a narrowing of surgical margins recommended or used for melanomas of all thicknesses. In addition, regional differences of the role of the dermatologist in surgical management of patients with MM were observed. Conclusion: An increasing proportion of dermatologists are involved in the surgical management of patients with MMs. Most dermatologists appear to be in accord with the guidelines for surgical margins currently recommended in the literature.