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Skin cancer audits fuel minor surgery row

Dermatologists have courted further controversy over GP minor surgery, after launching a concerted attack on primary care management of skin cancer.

Three separate audits presented at the British Association of Dermatology annual meeting last week concluded skin cancer management in primary care was ‘suboptimal', and ‘demonstrated a worrying failure by GPs'.

The BAD called for secondary care dermatologists to continue to lead in the diagnosis of skin lesions, claiming that GPs were inappropriately skilled to treat skin cancers in primary care.

The research comes as the GPC is locked in a dispute with NICE over the ‘draconian' way in which some PCTs are interpreting the institute's skin cancer guidelines. The GPC believes an initial response from NICE to a written protest was inadequate and is pressing it further.

But the first dermatology first audit, of all patients given a skin biopsy in primary care over a 12-month period after NICE guidance was published in February 2006, found as many as 61% of the skin cancers analysed were being treated inappropriately in primary care. Only 47% of basal cell carcinomas were completely excised.

‘NICE skin cancer guidelines are frequently not being adhered to which appears to be exposing many patients to unnecessary risk', researchers concluded.

A second audit found only 16 of 373 skin biopsies sent by GPs to a histopathology department at the Epsom and St Helier NHS trust during two months in 2007 were skin cancer. ‘GPs are still biopsying suspected malignancies and skin lesions for which they are unsure of the diagnosis', researchers concluded.

The third, an audit of 472 specimens assessed sent for analysis at the Royal Free hospital in London, found GPs were least accurate in clinical diagnosis when compared with consultant dermatologists and surgical specialists.

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