Development Of A Non-Melanoma Skin Cancer GP Referral Guideline; An Evidence-based Approach

Dr. Barbara MCGROGAN, King's Inns House, 200 Parnell St., Ireland
O'TOOLE D. 1 , NOLAN E. 1 , CODD D. 1 , MURPHY L. 1 , O'CONNOR D. 1 , FLYNN D. 1 , FOLEY D. 1

1 National Cancer Control Programme, King's Inns House, 200 Parnell St., Dublin 1, Ireland.

Non-melanoma skin cancer is the most common cancer in the Republic of Ireland. Ireland's incidence and mortality are steadily increasing; 9000 cases are diagnosed each year. Incidence will escalate; by 2040 it will increase by up to 356% in males and 235% in females (NCRI, 2014).

Achieving better patient outcomes depends on early recognition, prompt and appropriate referral, and multi-disciplinary specialist management. The National Cancer Control Programme (NCCP) identified a need for a referral guideline to assist General Practitioners (GPs) in the recognition of high risk non-melanoma skin cancer (NMSC) and advise on management and referral pathways.

An Expert Group was set up with representation from general practice, dermatology and surgery/plastic surgery. Key clinical questions were agreed for the literature review. Publications were appraised using either the AGREE II instrument or a methodology checklist for systematic reviews and meta-analyses. The guideline was developed by the Expert group prior to public consultation. Currently the guideline is in the final stages of development.

GPs should endeavour to identify high risk tumours at the earliest opportunity and refer patients with clinical or pathological features of high risk NMSC for specialist management and discussion at a Multi-disciplinary Meeting (MDM). Low risk lesions may be excised in Primary Care. The guideline clearly defines features of high risk basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) including images of the clinical features of these cancers. Pathways for management and referral of BCCs and SCCs are outlined. There is brief advice on primary prevention and early detection for patients.

This guideline has been devised by an Expert Group following critical appraisal of current evidence and public consultation. It will be circulated to all GPs and used to promote evidence-based pathways of care for patients presenting to their GP with NMSCs.