Skin excisions: Not so simple for the regionally based general surgical trainee

Abstract

This study's positive margin rate of 15.9% falls within the range reported in the literature (0.7% to 20.7%); however, this has the potential to be further reduced. Surgical registrars excising skin lesions in regional centres, regardless of level of training, should have closer supervision. Regular surgical audit should be done so registrars can have early feedback on performance.

Matter of margins

“…In literature, the improper intra‐operative evaluation of the extent of the tumour, implies an inadequate judgment in the assessment of proper surgical margins and so it is related to high inadequate excisions . Furthermore, the diagnostic accuracy of preoperative recognition of tumour margins is the predictive factor responsible for an increased percentage of incomplete excisions . Hence, there is evidence that adequate training of the surgeon to better recognize clinical margins of the tumour rather than possession of a surgical technique ensures the best efficacy in tumour treatment.…”

Outpatient surgical management of non‐melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes

“…Contemporary research, particularly in the context of the head and neck, has also supported a 3‐mm margin for BCC 12,13 . The rate of incomplete excision of BCC in the literature ranges between 4.4% and 14.7% increasing up to approximately 20–61.5% for the face, nose and ear 7–9,14 …”

“…12,13 The rate of incomplete excision of BCC in the literature ranges between 4.4% and 14.7% increasing up to approximately 20-61.5% for the face, nose and ear. [7][8][9]14 For primary cutaneous SCC, recommended margins are 4 mm for low-risk and 6 mm for high-risk lesions, with high-risk lesions including lesions of the ears, nose and lips. 15 However, margin control in the high-risk areas of the head and neck, particularly in the context of anatomical and tissue constraints, can be difficult to achieve.…”

“…A study by Chan et al presents the difficulties of management of skin lesions in a regional surgical setting, calling for close supervision of junior doctors and surgical registrars, with the presentation of significantly higher positive margin rates when operating unsupervised. 9 It was a key component of this outpatient trial to be consultant-led and supervised at all times, and this is an important recommendation for future trials of this outpatient model. This study highlights the difficulties of providing cancer care in a regional setting, with 37.1% of patients living >100 km from the health service.…”

“…Increased management in a surgical outpatient setting represents a potential treatment pathway that promotes improved utilization of specialist resources. The literature presents a number of NMSC audits within the Australian population across primary care, dermatology, general surgery and plastic surgery departments 7–10 . There is, however, a paucity of literature on the outpatient management of NMSC of the head and neck, particularly in a regional setting and in the absence of alternative specialist services including plastic surgery.…”