382 Compliance With Current Excision Margin Guidelines for Non-Melanoma Skin Cancer: Do We Make the Cut?

Abstract

Aim Non-melanoma skin cancers (NMSC) are the most common malignancies worldwide, with basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) constituting an ever-growing clinical burden within Plastic & Reconstructive Surgery. In this 3-cycle Quality Improvement (QI) initiative we sought to evaluate and improve our unit’s compliance with British Association of Dermatology (BAD) guidance on excision margins for NMSCs. Method Following results from two Plan-Do-Study-Act (PDSA) cycles, a third retrospective review of clinic letters, operative notes and histopathology reports was undertaken to identify NMSCs that were excised during May 2021 and assess compliance with recommended excision margins according to risk stratification. Results The dissemination of cycle 1 findings at departmental meetings, as well as the implementation of guideline posters and operative note templates conferred a significant improvement in both clinical documentation (12% to 100%) and local compliance with excision margin guidelines for BCCs (53% to 71%) and SCCs (50% to 79%). Following the adoption of new BAD guidelines on SSC margins in early 2021, a third cycle comprising 42 lesions demonstrated a sustained improvement in clinical documentation (100%) after a 7-month period and similar guideline compliance rates for both BCC (67%) and SCC (78%). Conclusions Adequate excision margins in cutaneous malignant pathology are vital to ensure complete removal, thus minimising the risk of recurrence. Although improvement across the PDSA cycles has been sustained despite the introduction of new SCC margin guidelines, we aim to introduce further interventions such as a knowledge and practice survey to continue improving excision margin compliance.