A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial

Abstract

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Safety of community-based minor surgery performed by GPs: an audit in different settings

“…1 The GP surgeons in the current study appear to achieve higher standards of diagnosis, excision completeness, and use of histology than for those reported in that study. However, the range of conditions being operated on seems to be more extensive, and the numbers of pigmented lesions excised, which is at odds with national guidance.…”

“…A major trial suggested that the quality of minor surgery carried out in general practice is not as high as that carried out in hospital, although the difference was not great. 1 The investigators of that trial felt there were deficiencies in GPs' recognition of malignant lesions, and possibly in completeness of excision compared with hospital doctors. They stated:…”

Skin cancer excision performance in Scottish primary and secondary care: a retrospective analysis

“…The findings of poorer recognition of skin malignancy by GPs and poorer quality of skin cancer surgery in primary care compared with secondary care have been reported in other UK studies. 8,[13][14][15] Additional concerns around primary care skin cancer treatment stem from fewer primary care MM excision patients receiving specialist management, and GPs reportedly making less use of pathology services than secondary care doctors when conducting minor surgery. 14,15 Internationally, similar trends are reported, although differences between healthcare models, dermatology, and skin surgery training influence outcomes and make translation of findings to the UK less valid.…”

“…However, in the current absence of significant investment in primary care dermatological diagnostic skills and skin surgery training, and with UK health policy seeking to reduce delays to definitive cancer treatment, guidelines for primary care triage and referral of suspicious lesions for secondary care management appear to offer patients the best quality, and may be more cost-effective. 4,14 Given the rising incidence of skin cancer, it is not clear whether this approach is sustainable. Policymakers may wish to consider this area of service provision, particularly the proportion of low-risk BCC currently managed in Scottish secondary care, which may be more suitable for treatment closer to the patient's home.…”

A regional programme to improve skin cancer management

“…Standards are usually not monitored except by audit of individual doctors, with training generally being informal 'peer to peer' learning, with occasional continuing medical education activities. 2,3 and other countries [4][5][6][7] have shown that skin specialists diagnose and excise skin cancers better than GPs. GPs may unnecessarily remove benign lesions or, because of cost barriers for some patients, refer minor lesions to hospital clinics, placing a high demand on these services.…”