Skin shop: long-term management and follow-up of narrowly and incompletely excised non-melanomatous skin cancer.

Abstract

'Skin Shop' is a model of care at a high-volume tertiary centre that describes a registrar-lead skin cancer service under consultant supervision. Ninety-two percent of lesions are completely excised, 4.2% are narrowly excised and 3.2% are incompletely excised. Current international guidelines suggest re-excision of incompletely excised non-melanomatous skin cancer (NMSC); however, there is a lack of robust evidence to suggest how these lesions should be optimally managed. We describe how narrow and incompletely excised NMSC are managed in the 'Skin Shop' and present rates of recurrence. Retrospective analysis of all lesions excised between December 2014 and June 2019. Lesion type, histological margin, presence of high-risk features, management, presence of residual tumour in re-excision and follow-up duration were recorded. Rates of clinical recurrence were documented. From 5821 lesions excised, a total of 394 NMSC (245 basal cell carcinoma (BCC), 128 squamous cell carcinoma (SCC) and 21 Basosquamous cell carcinoma) were narrowly or incompletely excised. A total of 135 (34.3%) lesions were observed in clinic for recurrence, 133 (33.8%) lesions underwent re-excision, 81 (20.6%) lesions underwent GP surveillance and 14 (3.6%) lesions received radiotherapy. Mean specialist clinic follow-up was 12.4 months. Fourteen lesions recurred (3.5%, 10 BCC, 3 SCC, 1 basosquamous) of which 12 underwent re-excision. The risk of recurrence for narrow and incompletely excised BCC was 2.9% and 10%, respectively. The corresponding rates for SCC were 2.2% and 3.3%, respectively. Skin Shop is an effective model with low rates of narrow and incompletely excised NMSC. Risk of recurrence of these lesions is low with our current practice.