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GPs ‘outperform specialists’ on melanoma excision

By Lilian Anekwe

GPs can perform excisions of melanomas in their practices at least as well as specialist dermatologists and in some cases better, an analysis concludes.

The research is a direct challenge to controversial NICE guidance restricting GP excision of skin tumours, which the authors said should now be ‘re-examined'.

A review last year of the guidance on skin cancer relaxed some restrictions on GP surgery, but it continues to face heavy criticism for unfairly limiting GPs' freedom to operate, and being responsible for spiralling referrals to dermatology departments.

UK researchers conducted a blind analysis of 1,263 melanoma pathology reports sent to the Aberdeen Royal Infirmary between 1991 and 2007. They found no significant difference between excisions conducted in primary and secondary care – with 72.5% of 190 primary biopsies in primary care completely excised, compared with 69.7% of 698 excised in secondary care.

GPs outperformed specialists on excision of melanomas referred for a second opinion from pathology, removing 11.1% correctly compared with 7.1% completely excised in secondary care.

Dr Peter Murchie, senior lecturer in primary care at the University of Aberdeen and a GP in the city, led the study, published in the February issue of the British Journal of General Practice.

He concluded: ‘We found no evidence to support the belief that melanomas are more likely to be excised inadequately in primary care. Given drives to reduce diagnostic delays, and that GP excision results in more rapid diagnosis, guidelines should be re-examined.'

Dr Murchie told Pulse: ‘Patients benefit from GP procedures because waits are shorter. The findings will challenge the authority of dermatologists and surgeons who often believe only they have sufficient expertise to carry out melanoma excisions. Those in secondary care won't like this data – I'm waiting for a backlash.'

In 2008, a controversial NHS-funded study, conducted at Southampton General Hospital, concluded operations in primary care - including excision of skin malignancies - were neither safe nor cost-effective.

NICE guidance rules out excision of melanomas by GPs. The guidance was strongly challenged by the BMA, RCGP and Primary Care Dermatology Society, who forced the institute to relax requirements for GP surgeons to attend multidisciplinary team meetings.

Dr Soon Lim, an RCGP director of minor surgery and minor surgery GPSI in Watford, Hertfordshire, said the study was a ‘significant step' in challenging perceptions about GP surgery.

‘It is still a sad fact that dermatology does not feature strongly in undergraduate and postgraduate GP training,' he added.

NICE said it had no plans to update its guidance although reviews could be triggered under ‘exceptional circumstances'.

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