{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T23:07:07Z","timestamp":1765667227718,"version":"3.37.3"},"reference-count":16,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,10,25]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess compliance with 2010 National Institute for Health and Care Excellence (NICE) guidance on cancer services relating to the management of basal cell carcinomas (BCC) in the community, where except in specific circumstances it is recommended that only low-risk BCCs should be excised routinely.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>A retrospective observational study of the histopathology reports of BCC excisions received from primary care in two district general hospitals in the South of England. One hundred consecutive BCC excisions were analysed from each hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>The numbers of high-risk BCCs excised in primary care according to histological subtype, anatomical site and age and if these excisions were compliant with NICE 2010 guidance. Completeness of excision and mention of BCC on histology request were secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Histologically high-risk subtypes were present in 32% (64\/200) of BCCs excised in the community. Only 17\/64 were excised by general practitioners (GPs) who were accredited to do so. Non-compliance regarding anatomical site occurred in 16% of samples; only one was non-compliant regarding patient age. There was a high overall rate of complete excision (94.5%) with variation in presence of the term BCC on histology request forms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NICE 2010 guidance relating to BCC excision in primary care was not followed in a considerable number of cases. Compliance with NICE 2010 guidance depends on the ability to recognise high-risk BCCs clinically and manage appropriately. It also shows that despite close supervision by secondary care, there are still failures of compliance.<\/jats:p><jats:p>GP training in identification of subtypes of BCC might be improved, as well as an increase in numbers of GPs accredited to carry out high-risk BCC excisions. Difficulty in diagnosing high-risk histological subtypes of BCC preoperatively should be considered in any future revision of NICE guidance.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023299","type":"journal-article","created":{"date-parts":[[2018,12,2]],"date-time":"2018-12-02T20:45:17Z","timestamp":1543783517000},"page":"e023299","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["High-risk basal cell carcinoma excision in primary care: a retrospective observational study of compliance with NICE guidance"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9483-082X","authenticated-orcid":false,"given":"Simon John","family":"Cole","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Howes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Meehan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Cole","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,2,22]]},"reference":[{"key":"2024051713435740000_8.11.e023299.1","unstructured":"National Institute for Health and Clinical Excellence. The management of low-risk basal cell carcinomas in the community. NICE guidance on cancer services update to CSG8 (May 2010). 2010 https:\/\/www.nice.org.uk\/guidance\/csg8\/resources\/improving-outcomes-for-people-with-skin-tumours-including-melanoma-2010-partial-update-pdf-773380189."},{"key":"2024051713435740000_8.11.e023299.2","doi-asserted-by":"crossref","first-page":"iii","DOI":"10.3310\/hta12230","article-title":"A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial","volume":"12","author":"George","year":"2008","journal-title":"Health Technol Assess"},{"key":"2024051713435740000_8.11.e023299.3","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(90)70344-H"},{"key":"2024051713435740000_8.11.e023299.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2230.2008.02710.x"},{"key":"2024051713435740000_8.11.e023299.5","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp16X684397"},{"key":"2024051713435740000_8.11.e023299.6","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/ced.12718","article-title":"Are there sufficient numbers of low-risk basal cell carcinomas to justify general practitioners (family physicians) carrying out basal cell carcinoma surgery?","volume":"41","author":"Fremlin","year":"2016","journal-title":"Clin Exp Dermatol"},{"key":"2024051713435740000_8.11.e023299.7","first-page":"0007","article-title":"Dermatology in the community: are guidelines being followed?","volume":"161","author":"Walsh","year":"2009","journal-title":"Br J Dermatol"},{"key":"2024051713435740000_8.11.e023299.8","first-page":"0007","article-title":"Will the introduction of new NICE guidelines change the management of basal cell carcinomas in the community?","volume":"165","author":"Alsharqi","year":"2011","journal-title":"Br J Dermatol"},{"key":"2024051713435740000_8.11.e023299.9","first-page":"0007","article-title":"Failure of adherence to NICE guidelines for skin cancer surgery in general practice","volume":"161","author":"Carter","year":"2009","journal-title":"Br J Dermatol"},{"key":"2024051713435740000_8.11.e023299.10","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X680929"},{"key":"2024051713435740000_8.11.e023299.11","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181ea450d"},{"key":"2024051713435740000_8.11.e023299.12","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200203040-00003"},{"issue":"Suppl 3","key":"2024051713435740000_8.11.e023299.13","doi-asserted-by":"crossref","first-page":"s20","DOI":"10.7861\/clinmedicine.16-3-s20","article-title":"Assessment of excision of basal cell carcinoma: did GPs really \u2019underperform'?","volume":"16 Suppl 3","author":"Rahim","year":"2016","journal-title":"Clin Med"},{"key":"2024051713435740000_8.11.e023299.14","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1159\/000371812","article-title":"Skin tumour surgery in primary care: do general practitioners need to improve their surgical skills?","volume":"230","author":"van Rijsingen","year":"2015","journal-title":"Dermatology"},{"key":"2024051713435740000_8.11.e023299.15","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.bjps.2015.12.024","article-title":"Basal cell carcinomata: Risk factors for incomplete excision and results of re-excision","volume":"69","author":"Masud","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2024051713435740000_8.11.e023299.16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.1365-2133.2009.09129.x","article-title":"Rate of incomplete excision of basal cell carcinomas by general practitioners with special interest","volume":"161","author":"Twist","year":"2009","journal-title":"Br J Dermatol"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-023299","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T23:30:30Z","timestamp":1715988630000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-023299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,2,22]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bmjopen-2018-023299"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-023299","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}