Variation in the Depth of Excision of Melanoma: A Survey of US Physicians

Mayo Clinic Consensus Recommendations for the Depth of Excision in Primary Cutaneous Melanoma

“…Recently (since the submission of our manuscript for review), DeFazio et al 27 reported the findings of their survey of 498 dermatologists caring for patients with melanoma. Survey results showed significant practice pattern differences: nondermatologists routinely resected more deeply than either specialist or nonspecialist dermatologists.…”

Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome

“…The fact that tumour thickness, being associated with local, regional and distant involvement, has an important effect on the prognosis and outcome of patients with melanoma leads to the consideration that the depth of surgical excision could also influence local recurrence . Although the depth of the melanoma excision has conventionally been to the muscle fascia or deeper, there is currently no sound scientific evidence for or against excision of fascia . The absence of a direct evidence‐based standard leads to a wide spectrum of management protocols .…”

“…8 Unfortunately, these guidelines do not make direct recommendations about the depth of excision. 9 Lack of evidencebased data therefore results in significant variations among surgeons regarding removal or preservation of the deep muscular fascia at the time of wide local excision for primary cutaneous thick melanomas. [8][9][10] Our goal was to assess the effect of excision or preservation of the deep muscular fascia on the outcome parameters of patients with primary cutaneous melanoma with a Breslow depth of ≥ 2 mm excised with 1-cm tumour margin.…”

“…Nevertheless, the optimal depth of excision remains unknown, although it is possible that the depth of excision may be as important as the width of excision for primary melanoma . Unfortunately, these guidelines do not make direct recommendations about the depth of excision . Lack of evidence‐based data therefore results in significant variations among surgeons regarding removal or preservation of the deep muscular fascia at the time of wide local excision for primary cutaneous thick melanomas …”

Lack of strong evidence with regard to the depth of thick melanoma excision

“…Unfortunately, the optimal depth of excision remains unknown, and the current melanoma guidelines do not make direct recommendations on the depth of excision . Therefore, this lack of evidence‐based data causes significant heterogeneity among surgeons, even in a single centre, with regard to the removal or preservation of the deep muscular fascia at the time of wide local excision for primary cutaneous thick melanomas . It is obvious that randomized controlled trials (RCTs) are the reference standard to assess efficacy.…”