Peter Murchie
Background Primary excision of melanoma is often undertaken by general practitioners (GPs),usually inadvertently. It may be that primary excision in general practice leads to earlier diagnosis and definitive treatment.Objectives To compare the duration of different components of treatment delay in patients receiving primary excision of cutaneous malignant melanoma in primary care with those receiving primary excision in hospital.Patients and methods One-hundred and forty two people diagnosed with melanoma between 1994 and 2004 and currently receiving structured hospital follow-up were studied. Key dates and clinical information detailing the diagnostic pathwaywas abstracted from patients’ general practice case notes.Results Twenty-eight percent of primary biopsies had been undertaken by GPs. The proportion of inadequate biopsies was similar for GPs and hospital doctors. Primary biopsy by a GP resulted in earlier diagnosis but did not reduce the time todefinitive treatment.Conclusions A sizeable proportion of melanomas are inadvertently excised in general practice, resulting in an earlier diagnosis but not earlier definitive treatment. GPs may no longer be more likely to inadequately excise pigmented lesions. Further researchis required to elucidate the future role of primary biopsy by GPs in the diagnosis and management of pigmented lesions.
