Removal of potentially cancerous moles by general practitioners (GPs) has come under the scanner in the UK. Audit shows that in almost half the cases it is not removed completely. That means the cancer could spread.
The National Institute for health and Clinical Excellence (Nice) is to review the guidance stipulating which GPs can diagnose and remove low risk skin cancers.
AdvertisementThere are three main types of skin cancer - basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma.
Nice guidance introduced in 2006, said that for low-risk BCCs, the least deadly type of skin cancer, treatment can be carried out either in primary care by a GP who has had extra training as a member of a specialist multidisciplinary team, or in secondary care, usually by a dermatologist.
However, any lesion that might be a high-risk BCC, an SCC or a melanoma, or where the diagnosis is uncertain, must be referred straight to a specialist and these cancers should not be treated by GPs.
Audits carried out since the guidance was published have shown that between 30 and 46 per cent of leisons removed in primary care were not completely excised, Telegraph reported.
Other findings showed that GPs attempted to remove lesions that should have been referred straight to specialists and in some cases the operation was not done by a GP who was a member of a specialist team or with a special interest in dermatology.
Nice has now announced the review after GPs and dermatologists could reach an agreement on the criteria family doctors should fulfil before attempting the surgery.
A statement from Nice said: "Some GPs believed that the requirements, especially attendance at hospital multidisciplinary team meetings, were unnecessarily onerous and in some areas it was believed that there was a threat to GP minor surgery in general."
Dr Fergus Macbeth, director of the clinical guidelines programme at Nice said it was unlikely the review would make the requirements on GPs even more restrictive.
But Dr Mark Goodfield, President of the British Association of Dermatologists said: "We feel very strongly that in the interests of patient safety, the Nice guidance should be maintained and thoroughly implemented, and not relaxed. Evidence shows that where GPs do not comply with the guidance, patient care suffers.
"We hope that the outcome of the review will reflect this."
Attending meetings in hospital is vital for the ongoing education and review, it was argued.
Dr Laurence Buckman, Chairman of the British Medical Association's GP committee said: "We welcome Nice's review of its skin cancer guidance and hope that it will properly evaluate the important contribution played by GPs in treating skin cancer.
"Many patients find minor surgery in their local GP surgery more convenient and less stressful than treatment in hospitals. The requirement in the original guidance for GPs to attend multidisciplinary team meetings in hospitals threatened the viability of minor surgery services."
Prof Steve Field, president of the Royal College of GPs, said: "GPs must be competent to both diagnose and treat low risk basel cell carcinomas, they mustn't do operations in high risk areas like that face, head and neck, must always refer SCC, melanomas and anything they are not sure about. GPs should only do this if they carry out more than 30 a year, attend an annual multidisciplinary meeting and remain up to date and this is not something we would expect every GP to do, it needs expertise."
Skin cancer is the most common form of the disease in 15 to 34 year olds with more than 100,000 cases a year in Britain. Cases of malignant melanoma, the most deadly form of skin cancer, has quadrupled since the 1970s to top more than 10,400 cases a year.
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