Dr Joanna Fawcett Dr Jonathan Wordsworth Dr David de Berker

 At skin cancer MDT a group of lesions with narrow margins (<1mm) of excision cause debate: ◦ Limited subcutaneous tissue of the:  Elderly scalp  Dorsum of the nose  Dorsum of the hand ◦ Perineural or lymphovascular involvement

 At skin cancer MDT a group of lesions with narrow margins (<1mm) of excision cause debate: ◦ Limited subcut. Tissue of the:  Elderly scalp  Dorsum of the nose  Dorsum of the hand ◦ Perineural or lymphovascular involvement  Patients diagnosed Jan

1. Qualifying tumours will have a management plan arising from the MDT (NICE IOG Guidance 2006) 2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person (NICE IOG Guidance 2006) 3. A follow up plan was determined by the MDT (NICE IOG Guidance 2006) 4. The follow up plan was within SSG guideline (SSG management of SSC guideline) 5. There is evidence in the clinical notes that the MDT follow up plan was undertaken (NICE IOG Guidance 2006) 6. The outcome at 5 years post treatment will be documented in the hospital record (Provisional)

 Trusts involved in audit ◦ UHBristol ◦ NBT ◦ RUH (results pending) ◦ Taunton ◦ Gloucester ◦ Yeovil also ◦ Royal Devon and Exeter ◦ North Devon and Barnstaple

 Total number of patients:101

 Average age: 81  Age range: 41-97

1. Qualifying tumours will have a management plan arising from the MDT (NICE IOG Guidance 2006) 2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person (NICE IOG Guidance 2006) 3. A follow up plan was determined by the MDT (NICE IOG Guidance 2006) 4. The follow up plan was within SSG guideline (SSG management of SSC guideline) 5. There is evidence in the clinical notes that the MDT follow up plan was undertaken (NICE IOG Guidance 2006) 6. The outcome at 5 years post treatment will be documented in the hospital record (Provisional)

1. Qualifying tumours will have a management plan arising from the MDT 98% (NICE IOG Guidance 2006) 2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person 88% (NICE IOG Guidance 2006) 3. A follow up plan was determined by the MDT 61% (NICE IOG Guidance 2006) 4. The follow up plan was within SSG guideline 46% (SSG management of SSC guideline) 5. There is evidence in the clinical notes that the MDT follow up plan was undertaken 62% (NICE IOG Guidance 2006) 6. The outcome at 5 years post treatment will be documented in the hospital record 36% (Provisional)

∎ Recurrence ∎ No recurrence ∎ No information 8

∎ Offered monitoring ∎ Offered excision ∎ Offered radiotherapy

1. Qualifying tumours will have a management plan arising from the MDT 98% (NICE IOG Guidance 2006) 2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person 88% (NICE IOG Guidance 2006) 3. A follow up plan was determined by the MDT 61% (NICE IOG Guidance 2006) 4. The follow up plan was within SSG guideline 46% (SSG management of SSC guideline) 5. There is evidence in the clinical notes that the MDT follow up plan was undertaken 62% (NICE IOG Guidance 2006) 6. The outcome at 5 years post treatment will be documented in the hospital record 36% (Provisional)

 Approximately 11% recurrence rate  All recurrences from scalp or head and neck  ? Relevance of peripheral margins

 David de Berker  Jonathan Wordsworth  Julia Griffith  Sally Hawkins  Jessica Painter  Trudy Gale  Helen Dunderdale  Chris Bower  Noel Au-Yeung  Mihaela Savu  Karen Davies  Rachel Wachsmuth  Amrit Darvay  Anita Takwale  Penny Williams  Jill Adams