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British Association of Dermatologists and Royal College of Pathologists
National clinical audit of NMSC excisions and completeness of histopathological
reporting 2016
AUDIT TITLE
National audit of non-melanoma skin cancer (NMSC) excision and completeness of
histopathological reporting.
BACKGROUND
NMSC is largely comprised of basal cell carcinoma (BCC) and invasive squamous cell
carcinoma (SCC). It is the largest category of cancer referred to secondary care for
management. Excision is the most common treatment (NICE Skin Cancer IOG 2006).
Completeness of excision is an important prognostic factor and marker for quality of care
(British Association of Dermatologists’ guidelines). Histopathological reporting is required to
define the nature of the pathology, management options and prognosis. Where
histopathological reporting matches the Cancer Outcomes Service Data requirements,
cancer service activity and national registration of cancer is enabled (National Cancer
Intelligence Network, Public Health England). The Cancer Outcomes and Services Dataset
(COSD) is a compiled dataset required to support implementation and monitoring of
Improving Outcomes: a Strategy for Cancer (IOSC).
This audit will entail contributions from participating clinicians in the United Kingdom with the
collaboration between the British Association of Dermatologists (BAD) and Royal College of
Pathologists.
AIM
1. To determine completeness of excision of a consecutive sample of basal cell carcinoma
(10) and invasive squamous cell carcinoma (5) provided by those personally treating, or
retaining responsibility for, skin cancer surgically.
2. To provide context to these results by determining case mix based on body site, tumour
size and comorbidities.
3. To determine completeness of the histopathological reporting to meet the needs of
Cancer Outcomes Service Data collection for the cases cited.
1
1
Excision
specimens of
NMSC will be
completely
excised
2
Histopathology
reporting of the
skin excision
specimens will
match the
Cancer
Outcomes
Service Data
dataset
100%
Criterion
Exceptions
Source
Improving Outcomes
for People with Skin
Tumours including
Melanoma
NICE IOG, 2006
None
Strength
of
evidence*
B/C
National Cancer
Intelligence Network
100%
No.
Target
AUDIT STANDARDS
None
Published cancer
service guidance
(NICE)
B/C
* Strength of evidence
A. At least one randomised controlled trial as part of a body of literature of overall good quality and consistency
addressing the specific recommendation
B. Availability of well-conducted clinical studies but no randomised clinical trials on the topic of the
recommendation
C. Expert committee reports or opinions and/or clinical experience of respected authorities. Absence of directly
applicable clinical studies of good quality
D. Recommended good practice based on clinical experience (local consensus)
DATA COLLECTION METHODOLOGY
☒ Casenote review
☒ Prospective data collection
☒ Data from existing databases
Pilot:
The 2014 BAD NMSC excision national audit served as a pilot for the clinical dataset
collection process. The histopathological element was piloted in 2015 through the BAD’s
Health Informatics sub-committee, with three clinicians auditing TEN BCC and FIVE SCC
excisions each for the clinical and histopathological datasets combined.
Skin surgeons, or those retaining clinical responsibility for patients referred to a surgeon, will
collect TEN consecutive cases of BCC and FIVE invasive SCC treated by excision based on
a pathology report with start date compatible with collection of adequate tumour numbers.
Tumours will be coded for the purposes of audit anonymization as BCC-1 (to 10) and SCC-1
(to 5). Clinical data sets will be provided through review of clinical notes or other sources.
Data will be entered into an updated version of the proforma used in the 2014 BAD NMSC
excision national audit. Corresponding histopathology reports will be downloaded and pasted
either as text or graphic format (JPEG/GIF/PNG) in the appropriately labelled spreadsheet
tabs within the Excel-based proforma.
2
Patient unit numbers, names, dates of birth and addresses will be removed, i.e. all submitted
data will be anonymised with respect to patient identity. Age will be categorised into four 20year bands as featured in the corresponding drop-down options in the proforma.
Participating
skin
surgeons
will
submit
completed
data
packages
to
[email protected] The Clinical Standards Unit at the BAD will verify the submitted
data. They will forward the histopathology reports to the audit coordinator of the Royal
College of Pathologists for the audit of completeness of COSD.
AUDIT SAMPLE
Selection criteria and time period:
Consecutive patients treated by excision surgery for BCC (TEN) and invasive SCC (FIVE) by
the primary clinician or named surgeon within 2015 if retrospective data collection is
undertaken.
Total number of cases:
Fifteen per participant/submission.
TIMESCALE
Commencement of data collection:
Monday 1st February 2016
Deadline for data collection:
Sunday 10th April 2016
Proposed date for publication of results:
Second half of 2016
3