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 inte rest and training in dermatologic surgery. Objective: Our purpose was to determine to what extent members of the American Academy of Dermato logy (AAD) are involved in the surgical management of patients with ma lignant melanomas (MMs), comparing 1982 with 1992. Methods: Members of the AAD practicing in the United States (N = 7412) were sent a questi onnaire that surveyed their role in the definitive treatment of patien ts with MMs and the surgical margins of normal-appearing skin that the y used or recommended for melanomas of various thicknesses. Results: S ixty-four percent of the respondents stated that they performed the de finitive surgery for in situ melanoma in 1992, a 14% increase from 198 2. 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 patien ts to surgical colleagues for definitive treatment. There has been a n arrowing of surgical margins recommended or used for melanomas of all thicknesses. In addition, regional differences of the role of the derm atologist in surgical management of patients with MM were observed. Co nclusion: An increasing proportion of dermatologists are involved in t he surgical management of patients with MMs. Most dermatologists appea r to be in accord with the guidelines for surgical margins currently r ecommended in the literature.