primary care, none had a possible diagnosis of melanoma on the request form, delaying pathological diagnosis, impeding clinico-pathological correlation, and correct diagnosis. Dermatologists expected melanoma in 54/60 and plastic surgeons in 29/43. Modern dermatological diagnosis of melanoma assisted by dermoscopy has a high sensitivity of 0.88 and specificity of 0.86. 4 In Murchie et als' study the correct diagnosis was only given in 19.5% of melanomas diagnosed in primary care. If services are provided by practitioners who are poor on diagnosis, irrespective of surgical competence, then unnecessary excisions will waste resources, and the risk of melanoma being missed is increased. The authors' assertion that if excision is complete then 'differences in diagnostic skill do not matter' is at least shortsighted or intended to provoke controversy.