Managing squamous cell carcinomas: audit on the mode of referral and adequacy of surgical excision

Abstract

vehicle containing propylene glycol, and the area treated became excoriated. After recovery to baseline renal function, cidofovir 1% gel once daily was started with excellent response and no side-effects. 10 No studies have been performed to investigate the bioavailability of topical or intralesional cidofovir in humans. 8 Rabbit studies suggest that propylene glycol, abrasion and occlusion increase skin absorption. 11 We did not monitor renal function in our patients, as blood tests are considered more invasive in the paediatric population and we were applying 1% concentration with ointment vehicle only (no propylene glycol). Application was under occlusion but patients were closely monitored for excoriation, inflammation or erosions.Cost is a limiting factor for the use of cidofovir. Cidofovir is however a relatively noninvasive therapy and a balance between cost efficacy and treatment morbidity should be considered. At this stage, treatment with cidofovir should probably be reserved for patients with severe persistent, resistant and symptomatic viral warts who have been compliant with previous treatments.In this retrospective study, four of the seven children with recalcitrant viral warts achieved long-lasting clearance in response to topical 1% cidofovir. There were no significant safety issues. This series supports the need for further studies to investigate therapeutic efficacy, safety and, importantly, cost effectiveness of cidofovir 1% ointment. Reference1 McKenna DJ, McGlennon S, McCallum M, Dolan OM. Evaluation of a novel 'needlecatcher' surgical instrument designed to reduce the incidence of needle stick injuries from suture needles during skin suturing. Br J Dematol 2008; 158:649-51.

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

“…Regarding margin involvement by tumour in excision biopsies, it is alarming that such a high percentage of those procedures carried out by GPs fell into this category. Our findings have been reproduced by other studies investigating excision biopsies of melanoma, 14,15 BCC 16–21 and SCC, 21,22 with incomplete excisions more commonly attributed to GPs than secondary care providers in each study. Incomplete excision rates are also high among plastic and other surgical specialities in our study, but this is likely to be largely explicable in terms of the more complex caseload taken on by these surgeons, with larger tumours tackled in more challenging anatomical locations.…”

“…Finally, it is of concern that a significant proportion of cases operated on by GPs should instead have been managed surgically in secondary care according to current NICE guidance for skin cancer. Several recent U.K. studies investigating dermatological surgical practice in primary and secondary care have highlighted this issue 22–26 . It has been suggested that patients may be exposed to unnecessary risk as a result, either through receiving inappropriate or inadequate treatment for their skin cancer, or being subjected to a delay in accessing definitive treatment 22,24,25 …”

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

“…Overall, incomplete excision rates in this audit for both BCC and SCC were 3%. This is low compared with previously published data, which has suggested incomplete excision rates of 7.5–16% for dermatologists, and is comparable to previous data for plastic surgeons (4–13%) . Incomplete excision rates in primary care and in other nonspecialist settings appear to be very variable, reported at between 1.6 and 43% .…”

Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology

“…Incomplete excision rates for cutaneous SCC in the literature range from 5% to 17.6% . Incomplete excisions frequently occur with cutaneous SCC of the head and neck and tend to occur at the deep margin of the excision .…”