Variation in the Surgical Care of Early Stage Melanoma Based on Surgical Subspecialty: Evaluation of Large Healthcare System.

OBJECTIVE

To investigate how different surgeons' subspecialties comply with treatment guidelines for early stage melanoma.

BACKGROUND

The National Comprehensive Cancer Network developed evidence-based guidelines for surgical margins, depth of excision, and performance of sentinel lymph node biopsy (SLNB) for cutaneous melanoma care. It is unknown how surgeons of varying subspecialties follow these guidelines.

METHODS

We included patients with primary cutaneous melanoma who underwent wide excision (WE) in 2022 across our healthcare system. We collected patients' clinicopathological characteristics, margin size, and depth of the WE, those who underwent SLNB and the treating surgeon's subspecialty.

RESULTS

Among 838 patients, 58.8% had T1 melanoma, 22.2% T2, and 18.9% T3-T4. Surgical oncologists (SO) performed most procedures (56.4%) followed by general surgeons (GS, 20.1%), dermatologists (Derm, 13.5%), otolaryngologists (ENT, 5.4%), and plastic surgeons (PS, 4.7%). Compliance with the recommended surgical margin size was highest for T1 (81.7%) and T2 (92.6%) compared to T3-T4 stages (64.2%; P < 0.0001). By subspecialty, Derm had the highest compliance rate with the margin size recommendations (93.3%) followed by SO (86.9%), PS (70%), GS (64%), and ENT (56.5%; P < 0.0001). Excision depth compliance increased with increasing T stage (P < 0.0001): 79.9%, 91.6%, and 92% for T1, T2, and T3-T4, respectively. 93% of eligible patients (T1b-T4) underwent SLNB.

CONCLUSIONS

Overall compliance with surgical margin size and excision depth was 80.8% and 84.8%, respectively. In our study, 93% of eligible patients underwent SLNB. Despite overall high compliance rates, we noted large differences in guideline compliance among the surgeons' subspecialty.