547 Evaluating the Excision and Diagnosis Rates of Non-Melanoma Skin Cancers in a Plastic Surgery Department

Aim

Skin cancer is the most common cancer in the UK. 95% of complete excision is considered the national average and achieving this is important for our patients and our practice.

The aims of our study were to evaluate our complete excision rates, sensitivity, and specificity in diagnosing and excising Non-Melanoma Skin Cancers (NMSC) as a department.

Method

We conducted a retrospective audit of adult patients undergoing excision of NMSC in our department in July 2022. Data was collected on age, gender, clinical and pathological diagnosis, surgeon grade, complications, site and subtype of lesion excised.

Results

Of the 100 cases identified, 43% of lesions excised were BCC and 22% were SCC. 72% of procedures were carried out by registrars. 98% of excisions were complete with 2 incomplete excisions and 13 excisions with narrow margins. 86% of specimens with narrow margins or incomplete excision were excised from craniofacial areas. Clinical diagnosis sensitivity for BCC was 79% and 86% for SCC, whereas specificity was 79% for BCC and 58% for SCC. The overall clinical diagnosis sensitivity for NMSC was 81% and negative predictive value was 88%.

Conclusions

Our complete excision rate and sensitivity is above the national average, however our ability to distinguish benign from cancerous lesions has room for improvement. This may reflect surgeon grade and concerns over prolonged waiting times delaying treatment. We therefore recommend regular skin cancer teaching and encourage all grades to use loupes, dermatoscopes and adequate lighting in clinic and theatre to ensure adequate margins and adherence to national guidelines.