Murchie P, Delaney E K, Thompson W D, Lee A J
Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK.
Clin Exp Dermatol. 2008 Aug;33(5):565-71. doi: 10.1111/j.1365-2230.2008.02710.x. Epub 2008 Mar 18.
General practitioners (GPs) are not encouraged to excise basal cell carcinomas (BCCs). Despite this, as many of 10% of BCCs may be excised by GPs. GPs may be able to have a greater role in the diagnosis and management of BCC, but much needs to be learnt before this can be advocated.
To compare the practice of GPs, skin specialists (dermatologists and plastic surgeons) and other hospital specialists in excising BCCs.
A retrospective analysis of all BCCs excised in the Grampian region between 1 January and 31 December 2005 was carried out In total, 1087 reports were rated for source, quality of clinical information provided and extent of excision.
GPs perform significantly less well than skin specialists when diagnosing and excising BCCs, but appear equal in diagnostic skill and better at excision than other hospital specialists. Non-specialized GPs appear to perform as well as GPs with special interest (GPwSI) in adequately excising BCCs. In 18.7% of all cases, the information supplied to the pathologist with the biopsy sample was inadequate to draw a conclusion.
GPs compare unfavourably with skin specialists in diagnosing and excising BCCs. The performance of nonspecialized GPs does not appear to differ markedly from that of GPwSI. There is considerable room to optimize current GP performance, particularly with lesions of the head and neck, and it may be that novel approaches to GP training are required to achieve this. Structured request forms may improve the quality of clinical information provided when skin biopsies are submitted for pathological examination.
一般不鼓励全科医生（GP）切除基底细胞癌（BCC）。尽管如此，仍有多达10%的基底细胞癌可能由全科医生切除。全科医生在基底细胞癌的诊断和管理中或许能发挥更大作用，但在提倡这点之前还有很多需要了解的。
比较全科医生、皮肤专科医生（皮肤科医生和整形外科医生）以及其他医院专科医生切除基底细胞癌的做法。
对2005年1月1日至12月31日在格兰扁地区切除的所有基底细胞癌进行回顾性分析。总共对1087份报告的来源、提供的临床信息质量和切除范围进行了评级。
在诊断和切除基底细胞癌方面，全科医生的表现明显不如皮肤专科医生，但在诊断技能方面似乎相当，且在切除方面比其他医院专科医生更好。非专科全科医生在充分切除基底细胞癌方面的表现似乎与有特殊兴趣的全科医生（GPwSI）相当。在所有病例的18.7%中，随活检样本提供给病理学家的信息不足以得出结论。
在诊断和切除基底细胞癌方面，全科医生与皮肤专科医生相比处于劣势。非专科全科医生的表现与有特殊兴趣的全科医生似乎没有明显差异。目前全科医生的表现有很大的优化空间，特别是对于头颈部病变，可能需要新的全科医生培训方法来实现这一点。结构化申请表可能会提高提交皮肤活检进行病理检查时提供的临床信息质量。
