Who should carry out skin cancer excisions? A systematic review

Abstract

Background:The incidence of melanoma and nonmelanoma skin cancers is increasing in the United Kingdom. Surgical excision carries the highest cure rates for all skin cancers and is the first-line treatment for melanomas and high-risk nonmelanoma cancers. This is most commonly performed by general practitioners (GPs), dermatologists, and plastic surgeons.Objective:The aim of this study was to identify which health-care professionals achieve the best outcomes following surgical excision of skin cancer lesions.Materials and Methods:A comprehensive search of the Cochrane Library and PubMed databases was conducted. PRISMA guidelines were adhered to throughout.Results:Six studies were identified and reviewed. Dermatologists were most likely to excise lesions adequately, and GPs were the least likely. Dermatologists displayed the greatest diagnostic accuracy, and excisions led by them had the highest overall and disease-free survival rates. Plastic surgeons were most likely to excise complex lesions on difficult-to-treat areas.Conclusion:Dermatologists can excise many skin lesions adequately, but plastic surgeons should continue to take an active role in complex or anatomically challenging lesions. There is a need for more validated training for GPs in the management of skin cancers. Further studies incorporating a randomized control protocol are needed to definitely assess who is best placed to surgically excise these lesions.

Disease Focused Integrated Care – a New Model of Healthcare Delivery for the Treatment of Skin Cancer

“…The requirement for specialist input has decreased steadily over the 7-year period studied, indicating an increase in their confidence and skills. In non-integrated settings, a systematic review showed GPs have significantly worse outcomes for skin cancer excisions than Dermatologists and Plastic Surgeons, with the main reason being a lack of training [25]. Further barriers for GP up skilling identified in a qualitative study include limited time and financial compensation for GPs, and a lack of trust from patients and Dermatologists in GP skills [26].…”

Basal Cell Carcinoma Excision Guided by Dermoscopy: A Retrospective Study in Macau

“…According to some studies, BCCs were more often excised by dermatologists, rather than plastic surgeons, presumably because the former group had improved clinical skills in recognizing and demarcating tumors, preoperatively. [11][12][13] Dermoscopy can increase the diagnostic accuracy for BCC; this technique is increasingly recognized as an important tool for BCC diagnosis, enhancing both sensitivity and specificity when compared to the naked eye. In addition improve diagnostic accuracy, several studies have reported that pre-surgical dermatoscopic margin assessments have improved BCC excision over clinical assessments alone.…”