title: Skin cancer excision performance in Scottish primary and secondary care: a retrospective analysis.
abstract: BACKGROUND
  In contrast with most published evidence, studies from north-east Scotland suggest that GPs may be as good at treating skin cancers in primary care as secondary care specialists.
  
  
  OBJECTIVE
  To compare the quality of skin cancer excisions of GPs and secondary care skin specialists in east and south-east Scotland.
  
  
  METHODS
  A retrospective analysis of reports from GPs in Lothian, Fife, and Tayside regions.
  
  
  METHODS
  Skin cancer histopathology reports from GPs in Lothian, Fife, and Tayside regions in 2010 were compared with reports from skin specialists in November 2010. The histopathology reports were rated for completeness and adequacy of excision.
  
  
  RESULTS
  A total of 944 histopathology reports were analysed. In 1 year, GPs biopsied or excised 380 skin cancers. In 1 month, dermatologists biopsied or excised 385 skin cancers, and plastic surgeons 179 skin cancers. 'High risk' basal cell carcinomas (BCC) comprised 63.0% of BCC excised by GPs. For all skin cancer types, GPs excised smaller lesions, and had a lower rate of complete excisions compared with skin specialists. A statistical difference was demonstrated for BCC excisions only.
  
  
  CONCLUSIONS
  GPs in east and south-east Scotland excise a number of skin cancers including malignant melanoma (MM), squamous cell carcinoma (SCC) and high-risk BCC. Despite removing smaller lesions, less commonly on difficult surgical sites of the head and neck, GP excision rates are lower for all skin cancers, and statistically inferior for BCC, compared with secondary care, supporting the development of guidelines in Scotland similar to those in other UK regions. Poorer GP excision rates may have serious consequences for patients with high-risk lesions.
authors: University of Edinburgh Medical School, Edinburgh, UK.
authors: Wei Yann
authors: WY
authors: Haw
authors: Department of Dermatology, Ninewells Hospital, Dundee, UK.
authors: Pariyawan
authors: P
authors: Rakvit
authors: Department of Dermatology, Queen Margaret Hospital, Dunfermline, UK.
authors: Susannah J
authors: SJ
authors: Fraser
authors: Department of Dermatology, Ninewells Hospital, Dundee, UK.
authors: Andrew G
authors: AG
authors: Affleck
authors: Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors: S Alexander
authors: SA
authors: Holme
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D001706:Biopsy / Q000706:statistics & numerical data*; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011050:Policy Making; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*
keywords: basal cell carcinoma; melanoma; primary health care; secondary care; skin surgery; squamous cell carcinoma