PATTERNS OF EXCISION AND REFERRAL FROM PRIMARY-CARE OF MELANOCYTIC LESIONS

There is debate about the margin of normal tissue that should be inclu ded with excisions of melanocytic lesions of the skin, and about which lesions should be referred for specialist care. We describe the deter minants of the margins of excised melanocytic skin lesions and of refe rral patterns from primary care. Copies of the pathology reports of me lanocytic skin lesions excised from two cities in tropical Queensland were obtained; questionnaires about each lesion were administered to t he excising doctor. Data about 3275 lesions (2914 naevi, 130 lentigos, 151 melanomas, 51 dysplastic naevi, 21 Hutchinson's melanotic freckle s and eight other melanocytic lesions) were analysed. Twenty-one per c ent of the treatment sessions involved the excision of more than one l esion; 5% involved three lesions or more. Most lesions were managed by one doctor. The overall mean margin of excision was 2.8 mm. It was gr eater for longer qualified doctors, surgeons and college-affiliated ge neral practitioners, for lesions excised to address malignancy (3.0 mm ) rather than cosmetic appearance (2.4 mm), for Hutchinson's melanotic freckles (5.9 mm) and melanomas (5.1 mm) compared with benign lesions (2.7 mm) (P < 0.001) and for older patients (2.6 mm for those less th an or equal to 15, 3.5 mm for those >40 years) (P = 0.001). Wider exci sions of skin melanocytic lesions are performed by older and more expe rienced doctors, on older patients, and for lesions in which malignanc y is being addressed.