232 Skin Cancer Histopathology Requests Within a Plastic Surgery ServiceD Stark, S Hendrickson
To ascertain whether plastic surgeons include adequate information on skin cancer histopathology request forms to aid accurate and timely histopathological diagnosis.
We completed a prospective closed loop audit on histopathology request documentation at a single centre over two two-week periods. The standards were agreed following multi-disciplinary discussion (dermatology, plastic surgery, and pathology) and based on the Royal College of Pathology dataset. Mandatory information was differentiated from desirable information. A poster intervention was introduced that illustrated the guidance. Inclusion criteria consisted of excision biopsies and wide local excisions performed under local anaesthetic in minor operating rooms.
Pre-intervention data included 45 lesions excised from 33 patients. A description of the lesion was documented in 26%, provisional diagnosis in 91%, lesion progression in 11%, surgical margins at the periphery in 56%, margins at deep in 16% and relevant past medical history (previous chronic lymphocytic leukaemia diagnosis and previous radiotherapy on that site) in 9%.
Post-intervention data included 45 lesions from 40 patients. There was improved compliance with all standards. A description of the lesion was documented in 76%, provisional diagnosis in 98%, lesion progression in 33%, margins at the periphery in 78%, margins at deep in 38% and relevant past medical history in 29%. Site and laterality were documented in all patients in both cohorts.
We observed improved documentation following a simple educational intervention. Further studies should aim to understand the impact this has on laboratory turnaround times, and further improve adherence to agreed guidance by incorporating mandatory fields in the request form.