Excising squamous cell carcinomas: comparing the performance of GPs, hospital skin specialists and other hospital specialists

Delaney, Elizabeth K; Duckworth, Laura; Thompson, W. D.; Lee, Amanda; Murchie, Peter

doi:10.1093/fampra/cms007

Cited by 19 publications

(34 citation statements)

References 12 publications

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“…We previously demonstrated that GP excision rate of skin cancer in three Scottish Health Boards was lower (76.9%) compared with those of secondary care dermatology (94.1%) and plastic surgery (89.3%), which concurs with other studies from Scotland and the Netherlands . However, other studies have reported that GPs excise NMSC as well as skin specialists . There is limited evidence assessing specifically whether GPs with a degree of skin surgery specialism or frequency of practice have superior excision performance.…”

supporting

confidence: 81%

Factors influencing skin cancer excision rates in Scottish primary care

Korgul

Holme

2018

Clin Exp Dermatol

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Skin cancer incidence rates are rising in the UK, yet many areas are experiencing a shortage of dermatologists. We sought to compare skin cancer excision rates between general practice (GP) surgeons to identify factors associated with good practice, through a retrospective analysis of GP skin cancer histopathology reports in three Scottish Health Boards over a 4-year period. Postal questionnaires were used to explore factors affecting surgeons' excision rates. GPs excised 895 skin cancers (4.5% of the 19 853 regional total) during the period. Of the basal cell carcinomas, 308 would be classified as low-risk by current National Institute for Health and Care Excellence criteria. Of the returned questionnaires, 58 accounted for 631 (70.5%) of the excised skin cancers. Analysing completeness of skin cancer excision, there was a statistically significant difference between GPs performing excision on ≥ 11 lesions/month compared with those performing excision on ≤ 10/month. Policymakers may wish to consider systems to facilitate low-risk patients being treated by GPs who undertake frequent surgical procedures.

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supporting

confidence: 81%

Factors influencing skin cancer excision rates in Scottish primary care

Korgul

Holme

2018

Clin Exp Dermatol

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“…Delaney et al [10] also noted that most histopathology forms of GPs and hospital specialists did not include a presumptive diagnosis. It may be concluded that many physicians are not aware of the fact that a diagnosis/consideration on the histopathology form may be of help for the pathologist in establishing the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Skin Tumour Surgery in Primary Care: Do General Practitioners Need to Improve Their Surgical Skills?

Rijsingen¹,

Vossen²,

Huystee

et al. 2015

Dermatology

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Background: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. Objectives: To assess surgical procedures used by GPs in skin tumour management. Methods: We performed a retrospective study of 1,898 pathology reports of skin tumours excised by GPs in 2009. Results: In 22.9% no diagnosis was provided on the application form. Mostly, once-off excisions (no preceding biopsy) were performed, 7% of the excised lesions were malignant, and 35% of incisions were incomplete. Excisions in the face and neck region were incomplete in 65.4%; 22% of melanomas were biopsied or shaved. Conclusion: This study underlines the difficulties in skin tumour management in primary care. To stimulate adequate resource use, the number of excisions of benign lesions could be lowered, and pretreatment biopsy in non-melanoma skin cancer management should be encouraged. GPs should be aware of their limitations and consider referral of high-risk malignancies.

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“…2 However, the same authors found that GPs performed as well, if not better, than specialists in excising squamous cell carcinomas (SCC); whereas, again, practicebased GPs performed as well as GPwSIs. 3 Further research by the same authors showed that melanoma excisions by GPs appeared to be of similar quality to those undertaken by specialists; there was no difference demonstrated between frequent and infrequent GP surgeons. 4 This article describes how GP minor surgery is taking place and they are removing pigmented lesions, despite national guidance that they should be referred to secondary care as GPs perform less well.…”

Section: Introductionmentioning

confidence: 93%