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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