Dr Joanna Fawcett Dr Jonathan Wordsworth Dr David de Berker.
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Transcript of Dr Joanna Fawcett Dr Jonathan Wordsworth Dr David de Berker.
SCC at “Tricky Sites” AuditAudit and quality control study of squamous cell carcinoma excised from scalp, nose, dorsum of hand with narrow deep margin (<1mm), and SCC with perineural or lymphovascular
involvement with <1mm any margin clearance at all body sites
Dr Joanna Fawcett Dr Jonathan Wordsworth
Dr David de Berker
At skin cancer MDT a group of lesions with narrow margins (<1mm) of excision cause debate:◦ Limited subcutaneous tissue of the:
Elderly scalp Dorsum of the nose Dorsum of the hand
◦ Perineural or lymphovascular involvement
Background
At skin cancer MDT a group of lesions with narrow margins (<1mm) of excision cause debate:◦ Limited subcut. Tissue of the:
Elderly scalp Dorsum of the nose Dorsum of the hand
◦ Perineural or lymphovascular involvement
Patients diagnosed Jan 2009-2010
Background
1. Qualifying tumours will have a management plan arising from the MDT (NICE IOG Guidance 2006)
2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person
(NICE IOG Guidance 2006)
3. A follow up plan was determined by the MDT (NICE IOG Guidance 2006)
4. The follow up plan was within SSG guideline (SSG management of SSC guideline)
5. There is evidence in the clinical notes that the MDT follow up plan was undertaken(NICE IOG Guidance 2006)
6. The outcome at 5 years post treatment will be documented in the hospital record(Provisional)
Standards (target 100%)
Trusts involved in audit◦ UHBristol◦ NBT◦ RUH (results pending)◦ Taunton◦ Gloucester◦ Yeovil
also◦ Royal Devon and Exeter◦ North Devon and Barnstaple
Casenote review
Total number of patients:101
Sample
Average age: 81 Age range: 41-97
Results: Epidemiology
7%5%
10%
37%
41%
Percentage of patients with co-morbidites
Dementia Warfarin ImmunesuppressionPacemaker Other No comorbidities
76%
24%
Sex distributionMale Female
Results
46%
22%
11%
16%
6%
Location of SCCs
Scalp Back of hand or foot
Nose Other head and neck
Other body
1. Qualifying tumours will have a management plan arising from the MDT (NICE IOG Guidance 2006)
2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person
(NICE IOG Guidance 2006)
3. A follow up plan was determined by the MDT (NICE IOG Guidance 2006)
4. The follow up plan was within SSG guideline (SSG management of SSC guideline)
5. There is evidence in the clinical notes that the MDT follow up plan was undertaken(NICE IOG Guidance 2006)
6. The outcome at 5 years post treatment will be documented in the hospital record(Provisional)
Standards (target 100%)
Results: Standard 1
98%
2%
“Qualifying tumours will have a management plan arising from the MDT “
(NICE IOG Guidance 2006)Yes No
Results: Standard 2
13%
23%
65%
“There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other re-
sponsible person” (NICE IOG Guidance 2006)
No evidence Letter to patient Appointment with patient Other
Results: Standard 3
61%
34%
5%
“A follow up plan was determined by the MDT” (NICE IOG Guidance 2006)
Yes No No information
Results – Analysis by site
Results: Standard 4
46%
26%
27%
“The follow up plan was within SSG guideline” (SSG management of SSC guideline)
Yes No No information
Results: Standard 5
62%
38%
“There is evidence in the clinical notes that the MDT follow up plan was undertaken”
(NICE IOG Guidance 2006)
Yes No
Results: Standard 6
36%
51%
13%
“The outcome at 5 years post treatment will be documented in the hospital record”(Provisional guidance)
Yes No No information
1. Qualifying tumours will have a management plan arising from the MDT 98%(NICE IOG Guidance 2006)
2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person 88%
(NICE IOG Guidance 2006)
3. A follow up plan was determined by the MDT 61%(NICE IOG Guidance 2006)
4. The follow up plan was within SSG guideline 46%(SSG management of SSC guideline)
5. There is evidence in the clinical notes that the MDT follow up plan was undertaken62%
(NICE IOG Guidance 2006)
6. The outcome at 5 years post treatment will be documented in the hospital record36%
(Provisional)
Standards (target 100%)
Results: OutcomesOutcome at 5 years
11%
70%
19%
Outcome at 5 yearsRecurrence No recurrence No information
Results: Outcomes
Nose Back of hand or foot Scalp Other head and neck Other body0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
90.00
Recurrence of SCC by location
Perc
enta
ge o
f SCC
s
3
0 0
18
4 9
30
72
12
2
0
3 3
∎ Recurrence
∎ No recurrence
∎ No information8
Results: Histological features
Results – Analysis by site
Results: Management decisions
Results – Analysis by site∎ Offered monitoring
∎ Offered excision
∎ Offered radiotherapy
1. Qualifying tumours will have a management plan arising from the MDT 98%(NICE IOG Guidance 2006)
2. There is evidence in the clinical notes that the MDT management plan was discussed/communicated with the patient or other responsible person 88%
(NICE IOG Guidance 2006)
3. A follow up plan was determined by the MDT 61%(NICE IOG Guidance 2006)
4. The follow up plan was within SSG guideline 46%(SSG management of SSC guideline)
5. There is evidence in the clinical notes that the MDT follow up plan was undertaken62%
(NICE IOG Guidance 2006)
6. The outcome at 5 years post treatment will be documented in the hospital record36%
(Provisional)
Standards (target 100%)
Approximately 11% recurrence rate
All recurrences from scalp or head and neck
? Relevance of peripheral margins
Conclusions
Action plan
David de Berker Jonathan
Wordsworth Julia Griffith Sally Hawkins Jessica Painter Trudy Gale Helen Dunderdale
Chris Bower Noel Au-Yeung Mihaela Savu Karen Davies Rachel Wachsmuth Amrit Darvay Anita Takwale Penny Williams Jill Adams
Thanks to…