Excising basal cell carcinomas: comparing the performance of general practitioners, hospital skin specialists and other hospital specialists P. Murchie, E. K. Delaney, W. D. Thompson* and A. J. Lee Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK; and *Department of Pathology, University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen, UK Summary Background. General practitioners (GPs) are not encouraged to excise basal cell carcinomas (BCCs). Despite this, as many of 10% of BCCs may be excised by GPs. GPs may be able to have a greater role in the diagnosis and management of BCC, but much needs to be learnt before this can be advocated. Objective. To compare the practice of GPs, skin specialists (dermatologists and plastic surgeons) and other hospital specialists in excising BCCs. Methods. A retrospective analysis of all BCCs excised in the Grampian region between 1 January and 31 December 2005 was carried out In total, 1087 reports were rated for source, quality of clinical information provided and extent of excision. Results. GPs perform significantly less well than skin specialists when diagnosing and excising BCCs, but appear equal in diagnostic skill and better at excision than other hospital specialists. Non-specialized GPs appear to perform as well as GPs with special interest (GPwSI) in adequately excising BCCs. In 18.7% of all cases, the information supplied to the pathologist with the biopsy sample was inadequate to draw a conclusion. Conclusions. GPs compare unfavourably with skin specialists in diagnosing and excising BCCs. The performance of nonspecialized GPs does not appear to differ markedly from that of GPwSI. There is considerable room to optimize current GP performance, particularly with lesions of the head and neck, and it may be that novel approaches to GP training are required to achieve this. Structured request forms may improve the quality of clinical information provided when skin biopsies are submitted for pathological examination. Introduction Basal cell carcinoma (BCC) is the commonest malig- nancy in the UK 1,2 and BCC incidence has risen significantly in the UK. 3 General practitioners (GPs) could be key to diagnosing and managing BCCs, but their ability to do so is questioned, and current guidelines do not identify a GP role. 4–6 Despite this, up to 10% of BCCs are excised by GPs. 3 Furthermore, Department of Health (DH) guidelines for appointing GPs with special clinical interest (GPwSI) in dermatol- ogy include surgery of solitary skin lesions as a core activity, albeit without explicitly recommending treat- ment of skin cancer. 7 BCCs grow slowly, rarely metastasize and are rarely fatal. Continuing to focus BCC management in hospitals will be increasingly costly. 8 Greater GP involvement in BCC diagnosis and management could benefit patients, Correspondence: Dr Peter Murchie, Cancer Research UK Research Training Fellow in Primary Care Oncology, Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK. E-mail: p.murchie@abdn.ac.uk Conflict of interest: none declared. Accepted for publication 12 October 2007 Clinical dermatology • Original article doi: 10.1111/j.1365-2230.2008.02710.x Ó 2008 The Author(s) Journal compilation Ó 2008 Blackwell Publishing Ltd • Clinical and Experimental Dermatology, 33, 565–571 565