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- Page navigation anchor for The importance of melanoma primary excision marginsThe importance of melanoma primary excision marginsI read the research paper by Murchie et al with interests.1 This is a useful piece of research demonstrating there is no trend towards poorer survival or differences in melanoma Breslow thickness with increasing rurality.1The role of primary care physicians in the surgical treatment of melanoma has been raised by the authors1 and further commented upon in the e-Letter by the president of the Association of Surgeons in Primary Care.2I am in full support of safe surgical procedures to be undertaken by trained practitioners in any safe setting. In the surgical treatment of skin cancers, including melanoma, it is important for trained practitioners to have fully familiarised themselves with the guidelines,3 especially in relation to excision margins. In brief, melanoma should be excised with an initial 2mm radial margin (primary excision) followed by discussion of management at a multidisciplinary meeting. Sentinel lymph node biopsy (SLNB; for diagnostic purposes) would be offered to patients with stage 1B or above melanoma, and this is carried out at the same sitting as the wide local excision surgery. If the primary excision radial margin is excessive, then it may be technically impossible to carry out a SLNB – which may in turn denying patients the choice of knowing about their SLNB status or the opportunity of enrolling into a future clinical trial (SLNB stat...Show MoreCompeting Interests: I am a final year dermatology registrar working in a secondary care setting.
- Page navigation anchor for Waiting times for suspected and diagnosed cancer patientsWaiting times for suspected and diagnosed cancer patientsThe waiting times standards for suspected and diagnosed cancer patients may be 2 weeks to the first specialist appointment but it is 62 days to the first treatment following the 2WW GP referral. This 62 day interval was met in only 82% of cases.1 This first treatment only includes the initial 2mm surgical margin excision biopsy with the MDT and secondary excision to follow. Furthermore the 2015 NICE Guidance on 2WW suspected cancer referrals was based on a 3% positive predictive value i.e. 97% of cases referred on this pathway are benign, We hear about secondary care dermatology departments not being able to cope with increasing workloads. However, only just under 60% of melanomas are referred through the correct 2WW pathway. Surely, it is time to consider the combination of essential dermoscopy skills by every GP surgery to exclude the unnecessary referrals of seborrhoeic keratoses and the controlled expansion of melanoma management into the selected trained, peer reviewed and audited GP NHS workforce? This must surely reduce the cost on the health economy whilst speeding the road to treatment with referrals armed with histology results.Reference1. NHS England. NHS England Annual Report and Accounts for 2016/17. Published date: July 2017. https://www.england.nhs.uk/wp-content/uploads/2018/07/Annual-Report-Full-201718.pdf.Competing Interests: As President of the Association of Surgeons in Primary Care, I support the shift of safe surgical procedures into the community when carried out by appropriately trained clinicians.