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At the heart of general practice since 1960

NHS Direct wrongly advises visits to GP

NICE is set to bar GPs with a special interest in dermatology from operating on malignant melanomas despite new research showing they are

more successful than hospital surgeons at carrying out treatment.

A study in the British Journal of Dermatology found GPs were twice as likely to carry out wider local excision than either general or plastic surgeons and achieved far better survival rates.

GPs now manage at least 15 per cent of melanoma cases and their results are even better than specialist dermatologists, the study found. But Pulse has learnt the new NICE guidelines, due out next summer, are expected to prevent GPs from managing all but the simplest cases of skin cancer.

Dr Stephen Kownacki, chair of the Primary Care Dermatology Society and a hospital practitioner in Northampton, said: 'Under the new NICE guidelines if a patient comes into general practice with a skin tumour GPs will probably only be allowed to deal with the simplest basal cell cancers, and definitely not melanomas.'

And Dr Dafydd Roberts, lead clinician for the NICE skin cancer guidance group, said: 'I can say quite clearly that it is my personal opinion that melanomas should not be dealt with in primary care.

'The vast majority of GPs simply do not have the training, expertise or facilities to treat them.'

NICE's position infuriated GPs who said they were perfectly capable of carrying out fast, high-quality surgery.

Dr Cornelius Crowley, a GP in Ealing with a special interest in dermatology, said the guidelines 'would be an issue for doctors who were perfectly competent in cutting'.

'I wouldn't recommend every GP chop a mole out if they see one, but there is no difficulty in an adequate GP treating a melanoma immediately.'

Over 90 per cent of GPs and dermatologists carried out wider local excision following initial excision but only 43 per cent of general surgeons and 25 per cent of plastic surgeons, according to the study of 1,536 melanoma patients.

Survival rates after 10 years were 78 per cent for GPs, 74 per cent for dermatologists, 53 per cent for general surgeons and 50 per cent for plastic

surgeons.

By Simon Crawshaw

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