Authors' response to Diagnostic biopsy of melanoma: primary or secondary care? Mortality and morbidity after initial diagnostic excision biopsy of cutaneous melanoma in primary versus secondary care

We disagree with the correspondents’ comment that, since the mean thickness
in both the primary and secondary care groups was ≤1mm, mortality and morbidity are not particularly relevant endpoints. We presented median and not mean values in our paper. In fact, over 40% of the lesions in each group of our study had a Breslow thickness ≥1mm. Furthermore, patients can die from melanoma irrespective of the Breslow thickness of the primary lesion, so
mortality was the most appropriate primary outcome for our study. Similarly, morbidity, in this case, subsequent hospital attendances, must be included in any analysis where questions of surgical competence are being addressed.
We salute the excellent model of care that the corresponders are advocating, and
implementing. However, they do not appear to provide any evidence as to why high quality skin biopsy of suspicious pigmented lesions in primary care could not be incorporated. We re-assert our conclusion that our study clearly signifies the need for a randomised controlled trial to establish the role of initial excision biopsy in primary care in the diagnosis and treatment of cutaneous melanoma in the UK. In the long run, this may be beneficial for both patients and the NHS.