Underuse of Wide Excision for Primary Cutaneous Melanoma in the United States

Abstract

Three randomized trials support wide excision (WEX) for primary cutaneous melanoma. The objective was to evaluate WEX use for melanoma in the United States. Patients with localized melanoma were identified from the Surveillance, Epidemiology and End Results database between 1988 and 1997. Associations between predictor variables and WEX compared to biopsy alone were evaluated using logistic regression. Of 8,268 patients identified, 74.9 per cent had WEX, whereas 25.1 per cent had biopsy alone. WEX use peaked in 1990 at 81.6 per cent and was lowest in 1995 at 69.8 per cent. Overall, WEX use decreased over time. WEX use was independently associated with Breslow thickness (odds ratio [OR] per 1-mm depth of invasion 1.4, 95 per cent confidence interval [CI] 1.3, 1.5), and was inversely related to patient age (OR per 10 years of age 0.93; 95% CI 0.90, 0.96). As compared with the time period 1988 to 1990, WEX use declined during 1991 to 1993 (OR 0.71, 95% CI 0.60–0.83) and from 1994 to 1997 (OR 0.65; 95% CI 0.57–0.75). Many patients with localized melanoma undergo biopsy alone without a WEX. Use of WEX is associated with thicker melanomas and younger patients. Use of WEX has decreased over time, despite results from three randomized trials supporting its use.