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NICE will listen to anyone on its guidance

I read with interest your article 'NICE to snub GPs' success on skin cancer operations' (News, September 27). I think we need to get a few things into perspective. The vast majority of GPs are only too willing to refer suspected melanoma into an appropriate specialist clinic. This is my experience as clinical lead in a large multidisciplinary unit.

A recent audit of 500 referrals into the unit indicated that only four were undertaken by GPs when the working diagnosis was that of ?melanoma. Thirteen were removed in error, when the primary diagnosis was other than melanoma. The remainder referred direct.

Your article is about the 'chosen few' GPs who maintain an interest in surgery. Two are quoted in your article: one is chair of the Primary Care Dermatology Society and the other is a GP with a special interest in dermatology.

If GPs are to undertake skin cancer surgery then they must be prepared to be subjected to the same rigorous cancer guidelines that hospital colleagues are subjected to ­ regular attendance at centre MDTs, appraisal, audit, governance and continuing professional education.

They must be up to date with ongoing trials and aware of the medicolegal implications that could face them if deemed to be treating a cancer inappropriately.

The reason for the 50 per cent 10-year survival rate among plastic surgeons is purely due to case mix, with the thicker (poorer prognosis) tumours being referred into this specialty.

Finally, I believe NICE is working to facilitate this special group of GPs to continue their practice but within the guidelines stated above, working closely with their cancer centre.

Mr Barry Powell

National Clinical Lead for Skin Cancer and Plastic Surgeon


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