First, we would like to say that the National Institute of Health and Clinical Excellence skin cancer improving outcomes guidance (IOG), far from being arbitrary, was based on appraisal of a wide range of evidence. Regrettably, prior to the IOG, some high-risk skin cancer patients received treatment below an acceptable standard from less experienced practitioners, including curetted and otherwise incompletely excised melanomas, as well as melanomas that had been repeatedly frozen or simply misdiagnosed as benign. The IOG was intended to level up to best practice, and this has largely been achieved.
Results of the study by Murchie et al indicate that the GPs concerned carried out adequate excisions,1 but we are not told how many benign lesions were needlessly excised, nor is there information about quality of scars, follow-up, or other important factors. The IOG has delivered integrated services in which multidisciplinary teams provide evidence-based holistic …