Are foundation doctors equipped with the skills necessary for the assessment and referral of the patient presenting with a suspected facial skin malignancy?

Abstract

The incidence of Skin Cancer (SC) has increased in recent years with it being the most common cancer within the UK. The management of SC requires a multi-disciplinary approach involving dermatologists and surgical specialities. The current study aimed to assess the confidence of current foundation trainees (FT) in the assessment of facial skin cancers and referral for surgical management and reconstruction. An online survey was distributed via social media and completed by 142 FT across 13 deaneries. Two higher training respondents were excluded. 50% of trainees had only examined one or two SC patients and 25% had no experience in SC assessment. Most FTs were not confident in performing a full skin examination (90%), formulating differential diagnoses for a pigmented facial lesion (45%), or investigating a facial SC (87%). Facial defects requiring reconstruction (87%) were more likely to be referred to PS. Foundation trainees were not confident in performing full skin examinations nor formulating diagnoses for pigmented lesions. This is concerning given that the majority of FT will enter general practise and therefore exposure to SC will be common. This may in turn place greater burden on secondary care services such as dermatology and allied surgical specialities resulting in a greater caseload on an already stretched service. The integration of the British Association of Dermatology undergraduate syllabus into the medical school curriculum will improve confidence in the detection and management of SC at both undergraduate and postgraduate levels.