The Management and Treatment of Skin Cancer – Are We Doing it Right?

Objective: This study aims to identify whether the University Hospital of Lewisham is managing patients according to the published guidelines and to create local guidelines for the identification and management of squamous cell carcinomas.

Design: This was a retrospective cross-sectional standards audit of patients diagnosed with squamous cell carcinoma at the University Hospital of Lewisham. A total of twenty patients were chosen at random for this study (out of a total of 79) by the specialist registrar dermatologist using a random number generator. Patients were divided into low-risk, high-risk and not recorded risks of squamous cell carcinoma. The number of follow-ups and the duration of follow-ups per patient was recorded.

Main Outcomes and Measures: To determine whether high-risk and low-risk squamous cell carcinomas are being managed in line with up to date guidelines. This is measured by the number of follow-ups, the duration in months of follow up and the time between each follow-up appointment and appropriate definitive treatment.

Results: This study had a mean age of 75 at diagnosis of squamous cell carcinoma (range 55-92); 12 of these patients were male and 8 of these patients were female. When comparing high-risk and low-risk squamous cell carcinoma patients using an unpaired t-test there was no statistical significance (p=>0.05) in the length of follow up, the frequency of follow-ups or the time between each follow-up appointment. Only 60% of patients followed up were provided education on self-examination. 100% of patients received appropriate definitive treatment.

Conclusions and Relevance: Management of patients diagnosed with squamous cell carcinomas at the University Hospital of Lewisham could be improved, especially in patients with low-risk squamous cell carcinomas. By following the suggested guidelines, the trust could reduce follow up appointments and the duration of follow up for low-risk squamous cell carcinoma patients attending the dermatology clinic.