British Association of Dermatologists ( BAD ) National Audit on Non‐Melanoma Skin Cancer Excision 2016 in collaboration with the Royal College of Pathologists

Abstract

Background. We conducted a re-audit of the surgical practice of UK dermatologists for the treatment of nonmelanoma skin cancer and examined changes with reference to our previous audit in 2014. The audit was supplemented by a detailed assessment of completeness of the histopathology reports for each tumour. Methods. UK dermatologists collected data on 10 consecutive nonmicrographic excisions for basal cell carcinoma (BCC) and 5 for squamous cell carcinoma (SCC). Data were collected on site, preoperative diagnosis, histological diagnosis, proximity to previous scars, and histological deep and peripheral margins. Results. In total, 222 responses were received from 135 centres, reporting on 3290 excisions. Excisions from the head and neck accounted for 56.7% of cases. Tumour diameter (mean AE SD) was 11.4 AE SD 7.1 mm (maximum size 100 mm) and 97% of cases were primary excisions. BCCs and SCCs respectively accounted for 65.7% and 26.8% of total cases. Of the suspected BCCs and SCCs, 95.8% and 80.4%, respectively, were confirmed histologically. All margins for any tumour were clear in 97.0% of cases, and complication rate in the audit was < 1%. Of the 2864 histology reports evaluated, only 706 (24.6%) contained all core data items; 95% of these were structure (synoptic) reports. Commonly omitted items were level of invasion, risk and T stage, which were absent from 35.7%, 64.2% and 44.1% of reports, respectively. Conclusions. Diagnostic accuracy and complete excision rates remain high. Complication rates may be under-reported owing to lack of follow-up. Histopathology reporting has a greater chance of being complete if reports are generated on a fieldbased platform (synoptic reporting).

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta‐analysis*

“…A total of 106 832 BCC and 21 569 SCC excisions were included. These were excised from 53 796 patients across all studies (25 studies did not report the number of patients, instead reporting the number of lesions only) 16,17,34,49,59,60,62,68,69,71‐74,78,81,95,103,106,108,111,114,119,131,133,134 . The mean (± SD) age of patients undergoing BCC excision was 67·4 (± 14·9 years) and for SCC excision was 70·9 (± 14·1 years).…”

“…These factors would be best explored using Bayesian techniques. With SCC the margin used in different studies was infrequently reported in the larger studies 17,42,59,78,106,114,124,128 . When it was reported, several studies found no association between wider margins and reduced proportion of incomplete excision, 8,91 often as the deep margin was primarily affected 91 …”

“…This gave the quoted figure of a 5% incomplete excision rate; however, this is not based on clinical studies using surgical excision. Two large‐scale national audits of BCC and SCC excision by UK dermatologists have reported different proportions of incomplete excision of between 2·3% and 3% 16,17 …”

An Analysis of Biopsies for Suspected Skin Cancer at a Tertiary Care Dermatology Clinic in the Western Cape Province of South Africa

“…Of all skin lesions biopsied 45.5% of lesions occurred on the face reflecting the propensity for skin cancer to affect sunexposed sites. A recent British Association of Dermatologists National Audit on NMSC Excision also reported excisions from the head and neck to account for the majority (56.7%) of cases [22].…”

Global incidence of incomplete surgical excision in adult patients with non-melanoma skin cancer: study protocol for a systematic review and meta-analysis of observational studies

“…The figure of 5% incomplete excision with a 4-5-mm peripheral margin is therefore an estimation and not based on clinical evidence. Several previous large-scale studies such as two national audits of BCC and SCC excisions by UK dermatologists have reported an incidence of incomplete excision of between 2.3 and 3% [13,14]. There have been no previous systematic reviews on this topic.…”