Factors contributing to incomplete excision of nonmelanoma skin cancer by Australian general practitioners

Hansen, Craig, Wilkinson, David, Hansen, Mary and Soyer, H. Peter (2009) Factors contributing to incomplete excision of nonmelanoma skin cancer by Australian general practitioners. Archives of Dermatology, 145 11: 1253-1260. doi:10.1001/archdermatol.2009.270


Author Hansen, Craig
Wilkinson, David
Hansen, Mary
Soyer, H. Peter
Title Factors contributing to incomplete excision of nonmelanoma skin cancer by Australian general practitioners
Journal name Archives of Dermatology   Check publisher's open access policy
ISSN 0003-987X
1538-3652
Publication date 2009-11-01
Sub-type Article (original research)
DOI 10.1001/archdermatol.2009.270
Open Access Status DOI
Volume 145
Issue 11
Start page 1253
End page 1260
Total pages 8
Place of publication Chicago, IL, United States
Publisher American Medical Association
Collection year 2010
Language eng
Formatted abstract
Objective:  To study rates of incomplete excision of basal (BCC) and squamous (SCC) cell cancer by Australian general practitioners with a special interest.

Design:  Records review. Setting: A network of 15 primary care skin cancer clinics across Australia.

Participants:
  Fifty-seven physicians performing excisions of 9417 BCCs and SCCs in a single network of 15 primary care skin cancer clinics across Australia between 2005 and 2007.

Main Outcome Measures:  Rates of incomplete excision according to physician, clinic, anatomic location of the lesion, and whether a previous biopsy had been performed.

Results:  Four hundred forty-three of 6881 BCCs (6.4%) and 159 of 2536 SCCs (6.3%) were excised incompletely. Incomplete BCC and SCC excisions were more frequent on the head and neck (282 of 2872 excisions [9.8%] and 97 of 861 [11.3%], respectively) than elsewhere. Ears (74 of 388 excisions [19.1%]) and nose (78 of 546 [14.3%]) had the highest rates of incompletely excised BCCs, and ears (26 of 144 excisions [18.1%]) and forehead (20 of 157 [12.7%]) had the highest rates of incompletely excised SCCs. Of all BCC excisions, 67.3% were once-off excisions with no previous biopsy, and these excisions were more likely to be incomplete (odds ratio, 1.73; 95% confidence interval, 1.36-2.20) than those with a previous biopsy. There was, however, substantial variation in frequency of incomplete excision between clinics for BCC (ranging from 3.3% to 24.7%) and SCC (ranging from 0% to 17.2%) and between physicians within clinics(BCC ranging from 0% to 31.1%, and SCC ranging from 0% to 23.5%).

Conclusions:  Overall frequency of incomplete excision is low and similar to that in other reports. However, high frequency in high-risk sites, low rates of previous biopsy, and substantial variation in performance between physicians and clinics suggests there is significant opportunity to further improve health outcomes. ©2009 American Medical Association. All rights reserved.
Keyword Basal-cell Carcinoma
Margins
Audit
Efficacy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 10 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 13 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 07 Sep 2010, 13:02:07 EST