Survey of surgical management of malignant melanoma in Canada: optimal margins of excision and lymph-node dissection.

The feasibility of clinical trials involving the surgical management of primary melanoma was assessed through a survey of Canadian surgeons who treat this disease. Surgeons were polled as to their current practice regarding node dissection and margins of resection of the primary lesion. Their interest in randomized trials addressing these practices was also assessed. Two hundred and forty questionnaires were distributed to 20 centres across Canada. The total number of patients with melanoma seen annually by the 131 surgeons who responded was 790 - of the approximately 1000 new cases of melanoma diagnosed in Canada each year. Of responding surgeons, 63% currently perform wide excision (taking 3 to 5 cm of normal tissue) for lesions less than 1.5 mm in depth and 37% perform limited excision (including 1 to 2 cm of normal tissue). Of all surgeons responding, 76% were interested in a randomized trial comparing wide and limited excision in these superficial lesions. Currently, 90% of surgeons perform wide excision of lesions 1.5 mm or more in depth and 10% perform limited excision. Fifty-nine percent were interested in a randomized trial comparing wide and limited excision in these deeper lesions. Twenty-four percent of surgeons routinely perform prophylactic node dissection on all patients with lesions 1.5 mm or more in depth; 66% wait until there is clinical suspicion of nodal metastases and 9% follow some other policy. The results of this survey indicate that (a) surgical management is varied, (b) radical surgery remains common practice and (c) surgeons are interested in randomized trials that will determine optimal treatment.