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In 2006, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidance on improving outcomes for patients with skin cancer, including melanoma.1 This document was subject to wide consultation from patient groups, secondary care specialists, and GPs. The focus of the document revolves around patient pathways. It aims to direct patients to where they receive the best management at different points in their pathway. The summary states:> ‘All patients with a suspicious pigmented skin lesion … or where the diagnosis is uncertain, should be referred to a doctor trained in the specialist diagnosis of skin malignancy.’Where melanoma is the possible diagnosis, an urgent referral under a ‘2-week maximum wait’ policy should be made. The rationale for this is that most patients referred will not have melanoma and they do not need surgery to make a diagnosis, but the assessment will be made by someone with diagnostic experience of melanoma.The study by Murchie et al in this issue of the BJGP provides us with some comfort if the pathway in the NICE guideline is not followed in instances where a pigmented lesion …

To excise or not to excise? Should GPs remove possible melanomas?