Basal Cell Carcinoma - Community Surgery


What is the service?

Improved Outcomes Guidance for Skin Cancer published in February 2007 indicates that general practitioners should no longer knowingly treat basal cell carcinoma, excepting where particular provision is made for their accreditation, supervision, continuing education and attendance at MDTs. These enhanced governance requirements imply that it would no longer be cost effective for single practices to provide skin cancer care to their own patients only and services will be commissioned in community setting. To meet this requirement Nene and Corby CCGs have commissioned a community based skin cancer service to diagnose and treat patients with dermatological lesions suspected of being basal carcinoma, solar keratosis or other premalignant lesions.

Eligibility

Patients will be seen in a community clinic for assessment, investigation and treatment planning for the following core services:

  • Diagnosis and treatment including FP10 prescribing for actinic keratosis; the CCGs’ formulary should be followed
  • Suspected skin cancer services - rapid access one-stop shop for non pigmented lesions including biopsy and excision of low risk basal cell carcinomas and pre-malignant lesions
  • Appropriate follow up and liaison with Acute Trust based Cancer Multidisciplinary Teams
  • The service will provide the following:
    • Full diagnostic service with biopsy and reporting of results
    • Patient advice and education
    • Initial treatment surgical when required
    • Initial prescribing via FP10 prescription; the CCGs’ formulary should be followed
    • Follow up at a subsequent clinic appointment if necessary
    • Submit samples for histopathology, track results and assure these are acted on
    • Provision of written treatment plans and discharge summary for the patients GP within 5 working days

Exclusions

Patients with suspected high risk skin cancers, complex pathology or non cancer lesions for excision or incision will be excluded. This should be in line with current best practice and NICE guidance e.g. NICE Guidance on Cancer Services: Improving Outcomes for People with Skin Tumours including Melanoma (update): The Management of Low risk Basal Cell Carcinomas in the Community May 2010

  • High risk BCC is defined as:
    • Patient is 24 years old or younger
    • Immunocompromised patient
    • Genetically predisposed patients (e.g. Gorlin’s Syndrome)
    • Recurrent or incompletely treated BCC
    • Lesions on nose and lips( including nasofacial sulci and nasolabial folds) or around the eyes (periorbital) or ears
    • Lesions greater than 2 cm in diameter below the clavicle or greater than 1cm above the clavicle (unless they are a superficial BCC that can be managed non-surgically)
    • Flat lesion, hard thickened skin (appearance of morphoeic BCC)Poorly defined margins
    • Lesion is located over important anatomical structures, where primary surgical
    • Where closure may be difficult or where excision may lead to a poor cosmetic result
    • Histological subtypes: morphoeic, micronodular, infiltrative and basisquamous

This service is currently being provided by the following practices:

The Saxon Spires Practice

 


Last updated: 26 Feb 2019