Download SWAG_Audit_2016

Somerset, Wiltshire, Avon &
Gloucestershire (SWAG) NonMelanoma Skin Cancer Excision
Audit 2016
Daniel Keith – Dermatology Registrar
David de Berker – Consultant Dermatologist
[email protected]
Background
We are collecting data for our
personal records, local audit and
for submission to the national BAD
audit.
National audit only covers
dermatologists
Other work missed, e.g. CNS,
plastics, max facs.
There is a need for
network/regional audit.
Why else collect this data?
Being able to access data about your doctor is becoming the norm.
Many surgical consultants now have their performance published for patients to browse.
This is the future!
Method
Submissions invited from those treating skin
cancer in our regions.
BAD National NMSC Excision Audit data collection
tool distributed.
10
BCCs
5
SCCs
Consecutive excisions
Prospective if possible
Submissions accepted from anyone operating on
skin cancer in the region.
Analyses to mirror the national audit for
comparison
Complete excision of a BCC or SCC is adequate
treatment and completeness of excision is a NICE
standard.
15 respondents from 5 trusts.
Somerset, Bristol and
Gloucestershire
223 cases
36.9% data collected prospectively (compared to 44.8%
nationally.
207 cases with usable data for site.
Distribution mirrors national data
More noses
58.5% Head and Neck (58.3% national)
67.1% of reported work was BCC
As expected given the way data
was requested.
BCC and SCC most
common diagnoses.
MM a rare missed
diagnosis.
Mirrors national picture.
BCC
Clinical specificity 95.3%
Suspected BCC confirmed on histology
[95.8%]
SCC
Clinical specificity 86.3%
Suspected SCC confirmed on histology
[80.4%]
Mean size = 11.03mm (SD 5.71) (National 11.36)
Largest tumour 34mm
The majority of tumours are cut out with adequate margins measured on histology as 15mm lateral and deep
Re-excisions
9 Re-excisions v 214 Primary Excisions
1 Complication in each group
Within 10mm of a previous scar?
No SCCs
6 BCCs, 5 with info on site
- 2 limbs, 1 trunk, 1 nose, 1 cheek
Completeness of Excision
100% Lesions excised clear of the deep margins
98.2% Lesions excised clear of the lateral margins
[National98.2% deep / 99.9% lateral / 99.3% any
(2014)]
91.9% Lesions excised clear > 1mm from the deep margin
95.1% Lesions excised clear > 1mm from the lateral margin
89.2% Lesions excised clear > 1mm from any margin
Incompletely excised lesions. N=4
2 x BCC
1 x SCC
1 x MM
Key findings
Diagnostic accuracy high (95.3% BCC / 86.3% SCC)
BCC within limits expected from other literature
SCC higher than reported in literature [1]
Potential for bias with retrospective data and the way cases were
requested
Mean tumour size 11.03mm
Follows the national average
Defect sizes of 19mm with 4mm clinical margins (H+N)
Complications few but likely to be underestimated
Completeness of excision similar to published and guidelines
Clinical margins of 4-5mm should provide > 95% clearance rates. [2]
1. Ahnlide, Ingela, and Mats BjELLERUP. "Accuracy of clinical skin tumour diagnosis in a dermatological setting."
Acta dermato-venereologica 93.3 (2013): 305-308.
2. Telfer, N. R., G. B. Colver, and P. W. Bowers. "Guidelines for the management of basal cell carcinoma." British
Journal of Dermatology 141 (1999): 415-423.
Thank you
[email protected]