bccs & gps
DESCRIPTION
BCCs & GPs. Dr Victoria Brown Consultant Dermatologist West Hertfordshire Hospitals NHS Trust. Which are BCCs?. 4. 2. 3. 1. 6. 5. 7. Basal Cell Carcinoma. Commonest cancer in UK 60% of all skin cancers in UK 80% head & neck Slow growing Locally invasive Rarely metastasize. - PowerPoint PPT PresentationTRANSCRIPT
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BCCs & GPs
Dr Victoria Brown
Consultant DermatologistWest Hertfordshire Hospitals NHS Trust
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Which are BCCs?
12 3
4
765
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Basal Cell Carcinoma
Commonest cancer in UK 60% of all skin cancers in UK 80% head & neck Slow growing Locally invasive Rarely metastasize
Do NOT refer as 2 week wait
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12 3
4
765
Which BCCs are GPs “allowed” to manage according to NICE guidelines?
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NICE Skin Tumours (IOG) Improving Outcomes Guidance: Updated May 2010
Lesions suspicious of SCC/MM – 2 WW referral to dermatology
Pre-cancerous lesions (e.g. Bowen’s, AKs) can be treated by GP or referred to GPwSI or dermatologist
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NICE Skin Tumours (IOG) Improving Outcomes Guidance: Updated May 2010
Low risk BCCs may be managed in the community by:
1. GPs performing skin surgery within LES/DES framework
2. Model 1 practitioners: Group 3 GPwSI in dermatology & skin surgery*GPwSI in skin lesions & skin sugery
3. Model 2 practitioners: skin surgery only:nurse or GP**
*Guidance and competencies for the provision of services using GPwSIs : Dermatology and skin surgery 2007 ** National Cancer Peer Review Programme: Manual for skin cancer services 2008: skin measures
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Criteria for accreditation of DES/LES
Demonstrate competency in skin surgery (DOPS) Training in recognition & diagnosis of skin lesions All specimens histology Log book – inform patients of diagnosis/plan Quarterly feedback to PCT on histology Annual review of clinical cf histological diagnosis for all
low risk BCCs managed Annual attendance at skin cancer network meeting: CPD
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Additional Criteria for Accreditation of Model 1 Practitioners
Accredited by PCT according to national guidance for GPwSI
Linked to named LSMDT Attends 4 LSMDT meetings/year Skin cancer clinical practice audited annually Clinical governance/appraisal from PCT
New “GPwSI in skin lesions & skin surgery”: training & accreditation to the same standard as Group 3 GPwSI but for skin lesions only
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Criteria for accreditation of Model 2 Practitioners
Demonstrate competency in skin surgery (DOPS) Associated with a named LSMDT Perform skin surgery on pre-diagnosed skin cancers
receiving referrals from LSMDT member with agreed treatment plan
If GP: annual review of clinical vs histological diagnosis
annual attendance at Skin Cancer Network meeting
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High vs Low Risk BCCsLow Risk High Risk
Patient age >25 yrs <25 yrs
Immunosuppressed N Y
BCC above clavicle N Y
BCC diameter <1cm >1cm
“high risk” histological type N Y
Recurrent/previously incompletely excised N Y
Anatomically difficult/cosmetically imp site N Y
Ill defined margins N Y
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BCC Referral Form
Is patient:under 25 Y/Nimmunosuppressed Y/N
Is the lesion:Above the clavicle Y/N>1cm diameter Y/N
Recurrent/previously incompletely excised Y/NIn an anatomically difficult/cosmetically imp site Y/NIll defined margins Y/N
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BCC Histological Subtypes
Nodular Cystic Superficial Pigmented Morphoeic Micronodular Infiltrative Basosquamous
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Which BCCs are GPs “allowed” to manage according to NICE guidelines?
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49 yr old man: <1cm BCC on forearm
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Treatment options for low risk BCCs: observe
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Treatment Options for low risk BCCs: Surgery
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68 yr old man: 8cm BCC on back
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Treatment options for superficial BCCs: Surgery
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Non- surgical treatment options for superficial BCCs
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Non- surgical treatment options for superficial BCCs
Efudix cream
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Treatment options for superficial BCCs: photodynamic therapy
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High Risk BCCs
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Treatment Options for High Risk BCCs
MOHs Surgery
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Take Home Points
Determine if low or high risk BCC Low risk BCCs can be managed in primary care
NICE Guidelines 2010: accreditation = hoops! High risk BCC or unsure of diagnosis: Refer correctly
1st time: dermatology, plastic surgery
Often >1 BCC at initial consultation - full skin examination
Don’t forget patient education after 1st BCC
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Primary Prevention of BCCs
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Low Risk BCCs for DES/LES GP
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Low Risk BCCs for Model 1 or 2 practitioners