GPs as effective in skin cancer biopsies

PATIENTS with suspicious skin lesions are at no greater risk when biopsies are carried out by GPs rather than in secondary care settings, according to a new study published in the British Journal of General Practice.

Researchers at the University of Aberdeen found that patients who have their initial diagnostic excision biopsy in primary care actually experience fewer subsequent hospital admissions and fewer days in hospital.

Currently only 20 per cent of melanomas diagnosed in the UK are first biopsied in primary care as UK guidelines advise that any potential melanoma should be referred immediately to secondary care. The study of 1263 individuals - 262 of whom were diagnosed in primary care - showed there was no difference in all-cause or melanoma-specific mortality between those receiving their initial diagnostic excision biopsies in primary care or secondary care.

The researchers conclude that current guidelines might not offer patients the best opportunity of timely diagnosis and that there is a need for a randomised controlled trial to definitively establish the role of primary care in the treatment of cutaneous melanoma. They further recommend that the UK should look to countries, such as Australia, where the initial diagnostic biopsy of pigmented lesions in primary care is commonplace.

Dr Jonathan Botting, RCGP Clinical Champion for Minor Surgery said: "I support research that shows that GPs are as capable of undertaking minor surgical procedures as their hospital colleagues. In many ways the initial treatment of melanoma is the most straightforward surgery for any skin cancers. Peter Murchie’s paper demonstrates GPs can do this just as well as hospital doctors, and the long term outcomes appear to be cost effective.

"The most difficult part in the initial management of melanoma is not the surgery it is the diagnosis. Improved diagnostic accuracy comes with training and experience. With the incidence of melanoma doubling every 10 years the NHS needs to support suitably skilled GPs being involved in melanoma management as part of an extended, community based, cancer network."

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