National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

Published Date: 27th July 2022

Publication Authors: Nolan G, Pritchard-Jones R

Introduction
Keratinocyte or non-melanoma skin cancer (NMSC) is the most common malignancy worldwide, encompassing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The mainstay of treatment for NMSC is excision. The likelihood of recurrence is directly related to achieving tumour-free margins. Just 1 per cent of BCCs recur where margins are clear1,2, compared with 31–41 per cent when margins are involved3,4. Equivalent data for cSCC are lacking but, given the metastatic potential (5–47 per cent)5, complete excision is paramount. In the UK, the majority of complex and high-risk skin cancers are excised by plastic surgeons.

A systematic review was undertaken to establish the risk of incomplete excision from surgical excision6–8. National guidelines estimate the risk (for example 5 per cent)9, but these were extrapolated from Mohs micrographic surgery (MMS)10 rather than surgical excision studies. A meta-analysis7 of 110 non-Mohs clinical studies containing 53 796 patients established an incomplete excision risk of 11.0 per cent for BCCs and 9.4 per cent for cSCCs. Subgroup analysis of excisions performed by plastic surgeons showed incomplete excision in 9.4 per cent of BCCs and 8.2 per cent of cSCCs. Using this as the audit standard7, the primary aim of this study was to undertake a national audit of NMSC surgical excisions in UK plastic surgery units. The secondary aim was to identify risk factors for incomplete excision by plastic surgeons.

 

Nolan, GS; Pritchard Jones, RO et al. (2022). National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK. BJS. epub 27 Jul(.), p... [Online]. Available at: https://academic.oup.com/bjs/advance-article/doi/10.1093/bjs/znac232/6650374 [Accessed 15 August 2022]

 

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