Dermatological surgery: a comparison of activity and outcomes in primary and secondary care

Goulding, J. M. R.; Levine, Steven M.; Blizard, Robert; Deroide, Florence; Swale, V. J.

doi:10.1111/j.1365-2133.2009.09228.x

Cited by 31 publications

(38 citation statements)

References 15 publications

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“…(18)reportingsignificantdifferences between complete excision rates in nonmelanoma skin cancer between dermatologists versus plastic surgeons and GPs.…”

Section: Discussionmentioning

confidence: 97%

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Bowen’s Disease: A Six-year Retrospective Study of Treatment with Emphasis on Resection Margins

Westers-Attema¹,

Heijkant²,

Lohman³

et al. 2014

Acta Derm Venerol

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Bowen's disease is an in situ squamous cell carcinoma of the skin with various treatment modalities available. A major advantage of surgical excision is the opportunity to histologically examine the resection margins. There is no consensus about the most appropriate margin. This retrospective study evaluates the clearance rates achieved by excision with a 5 mm margin and estimates how that might change after fictitiously reducing the resection margin by 1 or 2 mm. Patients with histologically confirmed Bowen's disease were selected at the Maastricht University Medical Centre from 2002 until 2007. Surgical margins and complete excision rates were evaluated and histological slides were re-examined. To our knowledge this is the first study investigating the safety margin for Bowen's disease. As Bowen's disease is not an invasive disease, minimisation of healthy tissue excision is desirable. Our data show that a hypothetical reduction of the safety margin from 5 mm to 4 or 3 mm decreases the complete excision rate from 94.4% to 87% and 74.1%, respectively.

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“…(18)reportingsignificantdifferences between complete excision rates in nonmelanoma skin cancer between dermatologists versus plastic surgeons and GPs.…”

Section: Discussionmentioning

confidence: 97%

“…Intensive training on recognition and treatment of skin malignancies is therefore indispensable. The dermatologist must continue to have a leading role in diagnosis and (surgical) treatment of non-melanoma skin cancer, as advised by Goulding et al (18).…”

Section: Discussionmentioning

confidence: 99%

Bowen’s Disease: A Six-year Retrospective Study of Treatment with Emphasis on Resection Margins

Westers-Attema¹,

Heijkant²,

Lohman³

et al. 2014

Acta Derm Venerol

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“…Previous studies found similar proportions of complete BCC excisions; however, these studies lack a sample size calculation, subgroup analyses per tumor site and histological subtype, and logistic regressions [8][9][10][11]. Dermatologists probably excise BCC more often complete than GPs and plastic surgeons because dermatologists are specifically trained in BCC care during their 5 years of specialization, and dermatologists are more experienced in BCC care due to the high case load in their daily practice.…”

Section: Discussionmentioning

confidence: 97%

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

Ramdas

Lee

Beck³

et al. 2018

Dermatology

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Background: Due to the increasing incidence of basal cell carcinoma (BCC) and rising health care costs, health care insurance companies seek ways to shift skin surgery for BCC from secondary to primary care. Objectives: To study the differences in complete excision of BCC by general practitioners (GPs), dermatologists, and plastic surgeons. Methods: A retrospective cross-sectional study of pathology records of 2,986 standard excisions of primary BCCs performed by a GP, dermatologist, or plastic surgeon in the area of Southwest Netherlands between 2008 and 2014. To compare the risk of an incomplete BCC excision between the specialties, the odds ratio (OR) was used adjusted for patient age, sex, tumor site, size, and histological subtype. Results: BCCs were completely excised by GPs in 70%, which was lower than the 93% by dermatologists and 83% by plastic surgeons (p < 0.001). Compared to the dermatologist, BCCs which were excised by a GP were 6 times higher at risk of an incomplete excision (adjusted OR 6, 95% CI 5–8) and 2 times higher at risk when excised by a plastic surgeon (adjusted OR 2, 95% CI 2–3). Conclusion: BCCs were more often completely excised by dermatologists than by GPs and plastic surgeons. Dermatologists probably perform better because of their extensive training and high experience in BCC care. To minimize incomplete BCC excision, GPs should receive specific training before the shift of BCC care from secondary to primary care is justifiable.

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“…4 Surgery is still considered the first-line treatment in different European countries, and 57-87% of all BCCs are still treated by standard excision (SE). [5][6][7][8] In the current observational literature, 5-year recurrence rates for Mohs micrographic surgery (MMS) are reported to be 1Á0-6Á5% for primary BCC and 4Á0-10Á0% for recurrent tumours. 9-15 A large, 10-year followup randomized controlled trial of high-risk facial BCCs showed a difference of 7Á8% for primary and 9Á6% for recurrent BCCs in favour of MMS over SE, although only the latter reached statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread

Hoorens

Batteauw

Maele³

et al. 2016

Br J Dermatol

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Dermatological surgery: a comparison of activity and outcomes in primary and secondary care

Abstract: This study presents a strong case for dermatologists to continue to provide the lead in diagnosis of skin lesions, and in selection and execution of dermatological surgical procedures.

Cited by 31 publications

References 15 publications

Bowen’s Disease: A Six-year Retrospective Study of Treatment with Emphasis on Resection Margins

Bowen’s Disease: A Six-year Retrospective Study of Treatment with Emphasis on Resection Margins

Differences in Rate of Complete Excision of Basal Cell Carcinoma by Dermatologists, Plastic Surgeons and General Practitioners: A Large Cross-Sectional Study

Mohs micrographic surgery for basal cell carcinoma: evaluation of the indication criteria and predictive factors for extensive subclinical spread

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