1. British Association of Dermatologists National Clinical Audit Programme 2014: NMSC excision

2. BAD-BSDS national audit on non-melanoma skin cancer excision Audit contributorsBAD and BSDS members, with some contributions from non-members LeadsDavid de Berker, Adam Bray, Daniel Keith, M. Firouz Mohd Mustapa Audit standards source Amalgamation of BAD quantitative (auditable) standards for both BCC and SCC, derived from BAD clinical guidelines for the management of BCC and SCCBAD quantitative (auditable) standards Completion dateMay 2014 Number of contributors277 responses from 135 identifiable centres Number of patients2739 (n=2739) Data collection (n=277)

3. Excision sites (n=2738)

4. Pre-op diagnosis (n=2739) Histology (n=2739)

5. Clinical and histological correlation TypeNo. of cases% Correlation All2384/272887.1 – prospective1377/160086.1 – retrospective999/112888.6 BCC2045/216794.4 – prospective1149/122793.6 – retrospective889/93295.4 SCC328/49166.8 – prospective220/33665.5 – retrospective107/15369.9 Other NMSCs11/7015.7 – prospective8/3721.6 – retrospective3/339.1

6. Clinical and histological correlation (n=163)(n=122)

7. Types of excision and relative risk of complications Risk ratio of complication for re-excision = 1.92 (95% CI 0.80-4.62, p=0.18) Relatively small numbers of complications and re-excisions, therefore not statistically significant Possible under-reporting of complications due to most patients not being followed up in secondary care Relative risk of complications for re-excisions vs. excision ComplicationsExcisionRe-excisionTotal No2233752308 Yes75580 Total2308802388 Excision by type Excision (first treatment)95.2% Re-excision3.25% Punch biopsy (first treatment)1.53%

8. Types of excision and proportions by body site

9. (n=123) Location of histologically correlated excisions within 10 mm of a previous scar (n=21)

10. Deep and lateral margins of histologically correlated cases (n=1901)(n=305) (n=1938)(n=305)

11. Deep margins of histologically correlated BCCs – prospective vs. retrospective (n=1062)(n=832)

12. Lateral margins of histologically correlated BCCs – prospective vs. retrospective (n=1082)(n=849)

13. Deep margins of histologically correlated SCCs – prospective vs. retrospective (n=200)(n=104)

14. Lateral margins of histologically correlated SCCs – prospective vs. retrospective (n=199)(n=105)

15. Bleeding risk of histologically correlated cases TypeBleeding risk (aspirin & warfarin only)Complications BCC4069 (2.2%) SCC9510 (10.5%) SCC – deep margins BCC – deep marginsBCC – lateral margins SCC – lateral margins

16. Distribution of tumour diameter Number of tumours with recorded diameters = 2388 Mean diameter 10.61 mm, standard deviation 6.92, error 0.14 Skew +4.8 Largest tumour = 130 mm

17. Deep margins of histologically correlated BCCs – tumour size Largest tumour diameter