BCCs & GPs
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Transcript of BCCs & GPs
BCCs & GPs
Dr Victoria Brown
Consultant DermatologistWest Hertfordshire Hospitals NHS Trust
Which are BCCs?
12 3
4
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Basal Cell Carcinoma
Commonest cancer in UK 60% of all skin cancers in UK 80% head & neck Slow growing Locally invasive Rarely metastasize
Do NOT refer as 2 week wait
12 3
4
765
Which BCCs are GPs “allowed” to manage according to NICE guidelines?
NICE Skin Tumours (IOG) Improving Outcomes Guidance: Updated May 2010
Lesions suspicious of SCC/MM – 2 WW referral to dermatology
Pre-cancerous lesions (e.g. Bowen’s, AKs) can be treated by GP or referred to GPwSI or dermatologist
NICE Skin Tumours (IOG) Improving Outcomes Guidance: Updated May 2010
Low risk BCCs may be managed in the community by:
1. GPs performing skin surgery within LES/DES framework
2. Model 1 practitioners: Group 3 GPwSI in dermatology & skin surgery*GPwSI in skin lesions & skin sugery
3. Model 2 practitioners: skin surgery only:nurse or GP**
*Guidance and competencies for the provision of services using GPwSIs : Dermatology and skin surgery 2007 ** National Cancer Peer Review Programme: Manual for skin cancer services 2008: skin measures
Criteria for accreditation of DES/LES
Demonstrate competency in skin surgery (DOPS) Training in recognition & diagnosis of skin lesions All specimens histology Log book – inform patients of diagnosis/plan Quarterly feedback to PCT on histology Annual review of clinical cf histological diagnosis for all
low risk BCCs managed Annual attendance at skin cancer network meeting: CPD
Additional Criteria for Accreditation of Model 1 Practitioners
Accredited by PCT according to national guidance for GPwSI
Linked to named LSMDT Attends 4 LSMDT meetings/year Skin cancer clinical practice audited annually Clinical governance/appraisal from PCT
New “GPwSI in skin lesions & skin surgery”: training & accreditation to the same standard as Group 3 GPwSI but for skin lesions only
Criteria for accreditation of Model 2 Practitioners
Demonstrate competency in skin surgery (DOPS) Associated with a named LSMDT Perform skin surgery on pre-diagnosed skin cancers
receiving referrals from LSMDT member with agreed treatment plan
If GP: annual review of clinical vs histological diagnosis
annual attendance at Skin Cancer Network meeting
High vs Low Risk BCCsLow Risk High Risk
Patient age >25 yrs <25 yrs
Immunosuppressed N Y
BCC above clavicle N Y
BCC diameter <1cm >1cm
“high risk” histological type N Y
Recurrent/previously incompletely excised N Y
Anatomically difficult/cosmetically imp site N Y
Ill defined margins N Y
BCC Referral Form
Is patient:under 25 Y/Nimmunosuppressed Y/N
Is the lesion:Above the clavicle Y/N>1cm diameter Y/N
Recurrent/previously incompletely excised Y/NIn an anatomically difficult/cosmetically imp site Y/NIll defined margins Y/N
BCC Histological Subtypes
Nodular Cystic Superficial Pigmented Morphoeic Micronodular Infiltrative Basosquamous
Which BCCs are GPs “allowed” to manage according to NICE guidelines?
49 yr old man: <1cm BCC on forearm
Treatment options for low risk BCCs: observe
Treatment Options for low risk BCCs: Surgery
68 yr old man: 8cm BCC on back
Treatment options for superficial BCCs: Surgery
Non- surgical treatment options for superficial BCCs
Non- surgical treatment options for superficial BCCs
Efudix cream
Treatment options for superficial BCCs: photodynamic therapy
High Risk BCCs
Treatment Options for High Risk BCCs
MOHs Surgery
Take Home Points
Determine if low or high risk BCC Low risk BCCs can be managed in primary care
NICE Guidelines 2010: accreditation = hoops! High risk BCC or unsure of diagnosis: Refer correctly
1st time: dermatology, plastic surgery
Often >1 BCC at initial consultation - full skin examination
Don’t forget patient education after 1st BCC
Primary Prevention of BCCs
Low Risk BCCs for DES/LES GP
Low Risk BCCs for Model 1 or 2 practitioners