Authors’ response

We value the contribution from our GP colleagues in medical and surgical dermatology, and are keen to support safe, high standard, evidence-based patient care. We accept that further studies on skin cancer excision are needed. If practical experience or adherence to management guidelines correlates with excision results, we will have an evidence base to develop primary care management in Scotland and perhaps stimulate reassessment of National Institute of Health and Care Excellence guidance.

In terms of bias, the pathology reports are factual, and reported by pathologists, who are not dermatologists, GPs, or plastic surgeons. Sequential reports were analysed by a medical student, with no specific links to primary or secondary care. However, we agree with Dr Murchie’s suggestion that a year of secondary care data compared against a year of primary care data has merit, although actual numbers would then have been different by over a factor of 10, making data collection and comparison challenging. A month of secondary care data gave roughly equivalent numbers to a year’s primary care, making comparison easier.

We feel that our study provides a useful overview of current practice in primary and secondary care, over a wide population in Scotland. The surgical management of non-melanoma skin cancer in Scotland is not subject to guidelines, in contrast to England and Wales. We appreciate the constructive comments from Dr Chambers, and agree that the training, experience, and ability of individual GPs performing skin cancer surgery in Scotland will vary and that there will be some GPs who practise to a high standard with excellent results. Regular clinical audit of outcomes after skin cancer surgery in both primary and secondary care is essential.

We are pleased that our study has encouraged debate and further research. It also provides a benchmark for dermatological surgery practitioners to compare outcomes against those of their peers. The recently published SIGN guideline Management of Primary Cutaneous Squamous Cell Carcinoma may alter practice,² and we believe our study is timely in documenting practice before its introduction.

• © British Journal of General Practice 2014