Observational study of type of surgical training and outcome of definitive surgery for primary malignant melanoma

The incidence of primary cutaneous malignant melanoma continues to rise,1 coinciding with narrower excision margins of normal skin being recommended around primary melanomas. 2 3 The bulk of surgery for primary melanoma is now done on an outpatient basis under local anaesthesia. This change has occurred at a time when training in dermatological surgery has developed, leading to a much higher proportion of excisions of primary melanoma being done by dermatologists. In 1979 in the west of Scotland only 3% of all primary melanomas were removed by dermatologists. By 1998 this figure had risen to 40%. Plastic surgeons now excise 26% of primary melanomas compared with 65% 20 years ago, and general surgeons excise 34% compared with 32%.