Skin Cancer and Primary Care
How do we detect skin cancer
At the moment there is no general screening programme in the UK for skin cancer. GPs and primary health care teams are the main source of dermatology referrals. Currently skin cancer referrals rely on ad hoc presentations within primary care appointments and incidental findings whilst examining alternative body systems. We also know the burden of timings for appointments with patients presenting with multiple lists of problems often leaving “can you quickly check this mole” to the end of an already brimming appointment.
How can GPs improve early identification of skin cancer:
There is no direct expectation that all GPs should be able to use a dermatoscope. The main role of dermoscopy in Primary Care is to be sure which are benign lesions not needing ongoing referral. The Primary Care Dermatology Society (PCDS) outline a clear statement on who should perform dermoscopy limiting it to those with ‘appropriate training’ in dermoscopy techniques. ‘Appropriate’ is defined as attending accredited RCGP dermoscopy courses which are held across Wales. Dermoscopy for absolute beginners is the basic course concentrating on differentiating between common benign lesions such as seborrhoeic keratoses, BCCs, and melanomas. RCGP courses in dermoscopy for intermediate and advanced practitioners aims to reduce the number of benign lesions referred unnecessarily to secondary care under the urgent suspected cancer referral pathways. PCDS state that ideally each GP practice should have at least one GP trained in the use of dermoscopy.
Which lesions are suitable for dermoscopy?
All benign skin lesions such as seborrhoeic keratoses, angioma, dermatofibroma and blue naevi can be identified with a dermatoscope. This can help reduce referrals and unnecessary skin surgery.
Pre-cancerous lesions such as actinic keratosis, Bowen's disease and basal cell carcinoma when identified under dermatoscope are better treated within primary care with improved diagnostic certainty and if needed referred on.
All melanocytic lesions suspicious of melanoma in terms of the history and naked-eye examination should be referred urgently to Secondary Care as an urgent suspected cancer, regardless of their dermoscopic appearance. Differentiating between various benign melanocytic naevi, atypical naevi and melanoma, can be challenging due to subtle dermoscopic features. (7)