title: Are there sufficient numbers of low-risk basal cell carcinomas to justify general practitioners (family physicians) carrying out basal cell carcinoma surgery?
abstract: BACKGROUND
  The incidence of basal cell carcinoma (BCC) is rising within the UK, and poses a significant workload on primary and secondary care services. Greater general practitioner (GP) involvement in the diagnosis and management of BCC has been suggested to reduce this burden. In 2010, the National Institute of Health and Care Excellence (NICE) produced guidelines on the management of low-risk BCCs by GP surgeons.
  
  
  OBJECTIVE
  To assess what proportion of BCCs are suitable for excision by GP surgeons, and to determine the potential demand for GP-led BCC surgery.
  
  
  METHODS
  A retrospective analysis was undertaken of all BCCs excised over 32 months for a population of 795 000 from the West Midlands region, UK. The data collected were reviewed against NICE criteria to determine the number of BCCs suitable for excision by GP surgeons.
  
  
  RESULTS
  In total, 1743 BCCs were excised over 32 months, a BCC excision rate of 82 per 100 000 population per year. Taking into account body site, diameter, histological subtype and other criteria, 3.0% (2.5 per 100,000 per year) of BCCs were considered low-risk according to the national criteria from NICE.
  
  
  CONCLUSIONS
  Low-risk BCCs suitable for excision by GP surgeons are of low prevalence and it would be difficult for GPs to maintain competencies in BCC surgery. Dermatologists should continue to provide the lead in skin cancer diagnosis, treatment and management.
authors.affiliation: Birmingham City Hospital, Sandwell and West Birmingham NHS Trust, Birmingham, West Midlands, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Fremlin
authors.affiliation: Walsall Healthcare NHS Trust, Walsall, West Midlands, UK.
authors.forename: P
authors.initials: P
authors.lastname: Gomez
authors.affiliation: Birmingham City Hospital, Sandwell and West Birmingham NHS Trust, Birmingham, West Midlands, UK.|Walsall Healthcare NHS Trust, Walsall, West Midlands, UK.
authors.forename: J
authors.initials: J
authors.lastname: Halpern
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000453:epidemiology* / Q000601:surgery; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000601:surgery