NICE updates skin cancer guidance

In collaboration with Adfero

The National Institute for Health and Clinical Excellence (NICE) has updated its recommendations on the diagnosis and treatment of 'low risk' basal cell carcinomas (BCCs).

GPs had raised concerns about the implementation of the institute's previous guidance in relation to the removal of 'low risk' tumours and the commissioning of services for skin cancer patients.

NICE announced a formal review of the recommendations in July 2009. The results of this review, by an expert group, mean that small skin cancers that are unlikely to spread can be removed by a GP rather than a specialist skin cancer surgeon, as long as the doctor has received appropriate and up-to-date training.

The institute's updated recommendation emphasises that primary care trusts (PCTs) or local health boards (LHBs) should ensure that all GPs who diagnose, manage and remove low-risk BCCs are fully accredited to do so.

GPs who treat BCCs must undergo continuous training in the diagnosis and management of skin lesions to maintain their accreditation, which should be performed locally by PCTs or LHBs.

Dr Fergus Macbeth, director of the NICE Centre for Clinical Practice, said that the institute had responded to doctors' concerns.

"BCC is the most common type of cancer in the UK, with an average of 48,000 new cases registered each year. However, because it is not fatal, its importance can be underappreciated," he claimed.

"It is vital that patients are accurately diagnosed, receive appropriate treatment and avoid unnecessary or incomplete surgery. We hope this updated guidance will ensure that patients get the care they need in the most appropriate setting."

Professor Steve Field, chair of the Royal College of General Practitioners, described the updated guidance as a "major step forward" for patients with skin cancer.

"Many patients will prefer to have minor surgery at their GP practice rather than going to hospital and the guidance acknowledges the important role of GPs in carrying out this treatment. But GPs are not expected to have expertise in this area so it is vital that we have a defined and consistent framework for referral when necessary," he explained.

"We are pleased that NICE has listened to the concerns of GPs and made the necessary adjustments that should now enable all healthcare professionals involved in the diagnosis and treatment of skin cancers to deliver a better deal for patients."

Hilary Tovey, Cancer Research UK's policy manager, said: "Cancer Research UK welcomes this update from NICE. In particular we welcome the emphasis in this guidance on ensuring that GPs performing this type of minor surgery are appropriately accredited and trained to do so.

"It will also be important to ensure that these doctors feel adequately equipped and supported to perform these procedures, and that patients are aware of their rights if they have questions or concerns about the treatment that is being offered to them."