The analysis by Dr Peter Murchie and colleagues at the University of Aberdeen shows that patients who have their initial diagnostic excision biopsy in primary care experience fewer subsequent hospital admissions and fewer days in hospital.
Although up to 20% of melanomas diagnosed in the UK have been first biopsied in primary care, current UK guidelines suggest that any skin lesion seen in primary care that could potentially be a melanoma should be referred immediately to secondary care.
However, the study – of 1263 individuals of whom 262 were diagnosed in primary care – shows there was no difference in all-cause or melanoma-specific mortality between those receiving their initial diagnostic excision biopsies in primary care or secondary care.
Data was taken from three data sets – the Grampian melanoma database, the General Register Office for Scotland death registry, and the Scottish Morbidity Record.
The research identifies three implications for the NHS:
- that patients whose melanoma was initially excised in primary care should be reassured that this does not mean impaired survival or increased morbidity
- that current guidelines might not offer patients the best opportunity of timely diagnosis and superior long term outcomes
- that there is a need for a randomised controlled trial to definitively establish the role of primary care in the treatment of cutaneous melanoma
It recommends that the UK should look to countries, such as Australia, where the initial diagnostic biopsy of pigmented lesions in primary care is commonplace.
Dr Jonathan Botting, RCGP Clinical Champion for Minor Surgery said: “I support research that shows that GPs are as capable of undertaking minor surgical procedures as their hospital colleagues. In many ways the initial treatment of melanoma is the most straightforward surgery for any skin cancers. Peter Murchie’s paper demonstrates GPs can do this just as well as hospital doctors, and the long term outcomes appear to be cost effective.
“The most difficult part in the initial management of melanoma is not the surgery it is the diagnosis. Improved diagnostic accuracy comes with training and experience. With the incidence of melanoma doubling every 10 years the NHS needs to support suitably skilled GPs being involved in melanoma management as part of an extended, community based, cancer network.”
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Please cite this research as: Br J Gen Pract 2013; DOI:10.3399/bjgp13X670697.
Authors: Peter Murchie, E Amalraj Raja, Amanda J Lee and Neil C Campbell.
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