Primary management of melanoma.

A questionnaire was sent to all consultant dermatologists in The Netherlands, Belgium and Scotland regarding their management of suspected melanomas. The 343 evaluable responses showed that 29.7% of the dermatologists regularly prefer to 'wait and see' or carry out incisional biopsies in the early management of suspected melanoma, especially if the risk is thought low. The main arguments advanced by the proponents of incision were doubts about whether incisional biopsy provokes metastatic spread, and the belief that a pathologist can make reliable diagnosis on a partial specimen of the tumour. These arguments are questioned and excision biopsy, provided it is feasible without being disfiguring, is strongly recommended in the initial treatment of a suspected melanoma.