NICE guidance on the excision of basal cell carcinomas (BCCs) in primary care are not being followed in a considerable number of cases, a new study has found.
The retrospective observational study, published in BMJ Open, examined histopathology reports of BCC excisions received from primary care in 2 district general hospitals in the south of England. One hundred consecutive BCC excisions were analysed from each hospital.
The research shows that almost a third (32%) of BCCs excised by GPs were histologically high-risk subtypes (64/200), even though the 2010 NICE guidelines state only low-risk BCCs should be excised routinely in the community. Only 17 out of the 64 cases were excised by a GP who was accredited to do so. Non-compliance regarding anatomical site occurred in 16% of the samples.
The authors say the study shows that compliance with NICE 2010 BCC excision guidance could be improved with further GP education, closer involvement with local skin multidisciplinary teams and a more straightforward progression to accreditation as model 2 practitioner status.
In addition, they say: “Consideration might be given to revising the NICE guidance, taking into account the difficulty of diagnosing high-risk histological subtypes of BCC preoperatively, which makes compliance with this parameter difficult.
“Although operating on a high-risk site or younger aged patient is avoidable, operating on a high-risk histological BCC is not. A revision of NICE guidance to allow for this could help to negate any perceived criticism of GPs who excise skin lesions in primary care, which is more convenient for patients and also reduces the pressure on secondary care,” they say.