Somerset, Wiltshire, Avon & Gloucestershire (SWAG) Non-Melanoma Skin Cancer Excision Audit 2016 Daniel Keith – Dermatology Registrar David de Berker – Consultant Dermatologist daniel.keith@nhs.net

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 1-5mm 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 [National 98.2% 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

Diagnostic accuracy high (95.3% BCC / 86.3% SCC) 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 daniel.keith@nhs.net