See-and-treat surgery for facial skin cancer

Skin lesion assessment and management model: optimising existing resources in the management of non-melanoma skin cancer

Abstract Background Skin cancer is a relatively common cancer in Australia, with early, simple treatment conferring a high likelihood of cure. Early diagnosis and treatment are important to reduce morbidity and mortality. A see-and-treat clinic seeks to offer earlier diagnosis and treatment as compared with a traditional model of care. The aim was to implement this model using pre-existing infrastructure with a hypothesis that this service will reduce wait times with reduced costs and high levels of patient satisfaction    Methods Referrals were screened and those suitable underwent consultation with a Plastic and Reconstructive Surgeon and same-day operative management with their choice of anaesthesia. Patients were reviewed 1 week and 4 weeks postoperatively.   Results 206 patients had 286 skin lesions removed over 23 operating lists. Over 75% of excisions were on the face. Local anaesthetic with sedation was the most popular anaesthetic technique There were 22 complications and the incomplete excision rate was 4.2%. Average wait time for SLAM-suitable patients reduced by 76%, and category 1 outpatient waitlists were reduced by 100%. An estimated gross saving of $1,339 per patient was calculated. A survey of patients post-operatively showed all patients would recommend this model.   Conclusion This see-and-treat model was shown to reduce wait times and cost, along with high levels of patient satisfaction. It was also easily implemented using pre-existing infrastructure. It is a service that continues to be offered and expanded, with ongoing patient satisfaction.

Impact of a see-and-treat melanoma clinic on patient experience

BACKGROUND

See-and-treat ('one stop') clinics for cutaneous and noncutaneous tumor streams have been shown to enhance patient experience, amongst other benefits, such as reduced waiting time to surgery if required. To date, there have been no studies assessing patient perception of one-stop clinics dedicated to the diagnosis and treatment of melanomas and pigmented lesions.

OBJECTIVE

To perform a prospective survey study examining patient's perception of a see-and-treat pigmented lesion clinic.

METHODS AND MATERIALS

Consenting patients were contacted by phone to complete a survey comprising 10 statements relating to different facets of the clinic, four weeks after their initial assessment. Reponses were documented on a 5-point Likert scale.

RESULTS

A total of 107/142 (75.4%) patients consented to partake in the study. Compared to overall mean response, patients who underwent same-day biopsy reported higher satisfaction (4.9 vs. 4.5, p < .01) and perceived convenience (4.8 vs. 4.4, p < .01). Of those who received same-day procedures, no patient reported being given insufficient time to consider surgical treatment.

CONCLUSION

A see-and-treat model for pigmented lesions, incorporating same-day excisional biopsy for lesions suspicious for melanoma, is viewed upon favorably by patients.

Outpatient surgical management of non-melanoma skin cancers of the head and neck in a regional centre: an analysis of costs and outcomes

BACKGROUND

Non-melanoma skin cancer is the most commonly diagnosed malignancy in Australia. Lesions of the head and neck are often outside the scope of primary care providers. The challenges of cancer care in regional Australia necessitate careful resource planning. This study presents an outpatient model that minimizes health service cost with local general practitioner follow-up.

METHODS

A retrospective review of 105 patients with 122 skin lesions in a dedicated Facial Lesion Assessment Management and Excision clinic was performed from July 2018 to 2019. Clinical outcomes, patient travel and cost analysis/comparison were recorded.

RESULTS

There were 85 malignant cases with 59 basal cell carcinomas and 25 squamous cell carcinomas. For basal cell carcinoma, clear margins (≥3 mm), close margins (<3 mm) and positive margins were achieved in 24 (48%), 23 (46%) and three (6%) cases, respectively. For squamous cell carcinoma, clear margins (≥5 mm), close margins (<5 mm) and positive margins were achieved in seven (38.8%), 11 (61.1%) and none (0%) of the cases, respectively. Complications included one haematoma and two wound infections. For 37% of patients living >100 km from the department, 72.3% had local general practitioner follow-up. Inpatient cost was $2870, $5697 and $9300 for primary closure, local flap and full-thickness skin graft, respectively, and outpatient cost was $746 for a single facial lesion.

CONCLUSION

This study presents a cost-effective model for the management of non-melanoma skin cancers with improved departmental efficiency and streamlined patient care in an outpatient skin cancer management model in a regional centre.

Effect of a See and Treat clinic on skin cancer treatment time

BACKGROUND

Many plastic surgery departments in Australasia have experienced increasing referrals for management of skin lesions. This has driven a demand for new strategies to decrease patient waiting time and administrative costs. The aim of this study was to determine if a purpose-built See and Treat skin cancer clinic could provide a faster skin cancer treatment pathway with comparable clinical outcomes and acceptability to patients.

METHODS

This was a prospective observational study of patients treated through the See and Treat clinic with a retrospective control cohort. The prospective 'See and Treat' cohort included a consecutive series of 106 patients, while the retrospective cohort included a consecutive series of 200 patients. Patient demographics, time from referral to surgery and operative measures were analysed. One hundred patients in the prospective cohort completed an anonymous satisfaction survey regarding their treatment.

RESULTS

The average time from referral to surgery was reduced from 121 days in the retrospective cohort to 60 days in the See and Treat cohort (P < 0.001). Rates of complete excision of malignant and premalignant lesions were not different between the two groups, being 93% (178/191) and 91% (76/84), respectively (P = 0.609). Ninety-five percent (95/100) of patients were satisfied with their See and Treat experience overall.

CONCLUSION

We show that a considerable reduction in the time between referral and surgery can be achieved through a See and Treat clinic without compromise of the success of surgical treatment. Moreover, such a treatment pathway has been shown to be acceptable, and largely preferable, to patients.

Positive predictive value of clinical diagnosis of head and neck non-melanoma skin malignancies. How accurate are we?

ᅟ: The purpose of the current study was to determine the accuracy of the clinical diagnosis in non-melanoma skin malignancy as confirmed by histopathological examination of the specimen. Positive predictive value (PPV) was selected as a reliable measure of diagnostic accuracy.

METHODS

Clinical diagnosis was made in the outpatient clinic by a consultant oral and maxillofacial surgeon. We reviewed the electronic charts of 210 patients with non-melanoma skin malignant tumours and calculated the positive predictive value of the initial clinical diagnosis. Histological confirmation for each lesion was compared with the provisional clinical diagnosis made in the clinic.

RESULTS

Of the 147 lesions provisionally diagnosed as basal cell carcinomas, 133 lesions were histologically confirmed to be basal cell carcinomas (BCC) (PPV 90.4 %). Of the 63 lesions provisionally thought to be squamous cell carcinomas, 47 lesions were histologically confirmed as squamous cell carcinomas (SCC) (PPV 74.6 %). The difference between the PPVs for the two types of malignancy in our study was not significant (p = 0.39). Statistics between our results for BCC and SCC and those reported from two other cancer institutes revealed no significant difference (p = 0.58 and 0.07).

CONCLUSIONS

The present study supports that relying on clinical diagnosis with the purpose to formalise a treatment plan for head and neck non-melanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma in comparison to suspected squamous cell carcinomas. Although positive predictive value represents a reliable measure of diagnostic accuracy, it is increased when populations with higher prevalence of the disease are studied.