I have long believed that the dermatology guidelines were flawed and that GPs were as good as secondary care at dealing with melanomas as well as non-melanoma skin cancers.
To support this I have audited my surgery and found the following.
In an all-career, all-procedures, all-reporting sources, all-causes analysis, my post-operative complication rate is 0.47%.
No lesion I clinically suspected of being a malignancy has ever been reported by the histologists as not being fully excised.
No malignant lesion has not been fully excised.
Over 27 patient years of cumulative surveillance for melanomas and squamous-cell carcinomas, there has only been one recurrence and that was in a squamous-cell carcinoma on which a dermatologist did the wider excision.
No melanoma was not suspected to be one.
My average wait from decision to excise to excision is five days, but for suspected squamous-cell carcinoma and melanomas it is usually the same day.
I curette hundreds of basal-cell carcinomas each year but also use efudix, cryotherapy and hot-wire cautery as well.
From Dr Paul Cundy
Wimbledon, south London
Dr Paul Cundy: Practice audit found all melanomas were properly excised