Dermatologists' Attitudes toward Ultrasound-guided One-step Excision for Cutaneous Melanoma: A Survey of Clinical Practice and Perceived Barriers

Wide local excision of primary cutaneous melanoma is usually performed in 2 stages: diagnostic excision followed by definitive surgery with margins based on histopathological Breslow thickness. High-frequency ultrasound may enable reasonably accurate preoperative thickness estimation and may allow a single-stage approach. However, its adoption in routine practice remains limited. This study evaluated dermatologists' acceptance of ultrasound-guided 1-step melanoma surgery and explored barriers to its implementation. An electronic survey including 9 clinical vignettes with dermoscopy images and preoperative ultrasound measurements was sent to dermatologists in the Loire Valley, France. Participants selected preferred management strategies, rated ultrasound utility and patient preference on Likert scales, and provided open-ended responses about perceived obstacles. Fifty-three dermatologists completed the questionnaire (57% response rate). One-step surgery was selected in 28% of scenarios, in creasing to 47% when diagnosis was confirmed by biopsy and decreasing to 24.5% without histopathological confirmation (p<0.0001). Most respondents acknowledged ultrasound's usefulness for thickness estimation (median Likert score 3 [IQR 3-4]) and believed patients would prefer a single procedure (median 4 [IQR 3-5]). Major barriers included limited access to high-resolution ultrasound (n=18), concerns regarding overtreatment (n=14) and medico-legal risk in the absence of histopathological confirmation (n=9). Dermatologists remain cautious about 1-step melanoma surgery, primarily due to diagnostic uncertainty and resource limitations.