NICE guidance on managing low risk BCCs May 2010
Key points
Low risk BCCs and premalignant lesions can be managed in primary care provided that those GPs "have specialist training in the diagnosis and management of skin lesions appropriate to their role"
- Accredited GPs performing skin surgery within the framework for DES and LES under GMS or PMS
- Model 1 practitioners defined by Manual for cancer services 2008 i.e. GPswSI
- Model 2 practitioners defined by Manual for cancer services 2008 i.e. outreach workers from secondary care
Definition of low risk BCCs
- Below the clavicle
- Patient over 24yrs
- No immunosuppression or Gorlin's syndrome
- Less than 10mm with clearly defined margins
- Is not a recurrent/persistent lesion following incomplete excision
- Not located over important structures (e.g. blood vessels, nerves), in an area where primary closure would be difficult (e.g. shin), an area which might give a poor cosmetic result or is highly visible where a good cosmetic result is important for the patient (e.g. anterior chest or shoulders)
- Is not morphoiec ,infiltrative or basosquamous in appearance
Criteria for accreditation of GPs
- demonstrate competency in LA, punch biopsy, shave excision, curettage, and elliptical excision using the DOPS tool in the DOH Guidance for GPwSIs in Dermatology and skin surgery and then follow a program of revalidation
- has specialist training in the recognition and diagnosis of skin lesions appropriate to their role
- Send ALL specimens to histology
- Provide info about the site of excision and provisional diagnosis on the request form
- Maintain a failsafe log of all procedures to ensure every patient is informed of the final diagnosis and advised whether further treatment or follow up is advised
- Provide quarterly returns to PCT as required by national skin cancer minimum dataset
- Should not knowingly excise other skin cancers
- Provide annual review of clinical v histological results (accuracy)
- Attend an educational meeting at least annually run by the Skin Cancer Network Site Specific Group. These meetings will run a minimum of twice per year and will present 6 monthly audit results including a breakdown of individual practitioner performance and include a 4 hr CPD session on skin lesion recognition and the diagnosis and management of low risk BCCs
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