Hansen Craig, Wilkinson David, Hansen Mary, Soyer H Peter
School of Medicine, University of Queensland, Herston Road, Brisbane, Queensland 4005, Australia.
Arch Dermatol. 2009 Nov;145(11):1253-60. doi: 10.1001/archdermatol.2009.270.
To study rates of incomplete excision of basal (BCC) and squamous (SCC) cell cancer by Australian general practitioners with a special interest.
Records review.
A network of 15 primary care skin cancer clinics across Australia.
Fifty-seven physicians performing excisions of 9417 BCCs and SCCs in a single network of 15 primary care skin cancer clinics across Australia between 2005 and 2007.
Rates of incomplete excision according to physician, clinic, anatomic location of the lesion, and whether a previous biopsy had been performed.
Four hundred forty-three of 6881 BCCs (6.4%) and 159 of 2536 SCCs (6.3%) were excised incompletely. Incomplete BCC and SCC excisions were more frequent on the head and neck (282 of 2872 excisions [9.8%] and 97 of 861 [11.3%], respectively) than elsewhere. Ears (74 of 388 excisions [19.1%]) and nose (78 of 546 [14.3%]) had the highest rates of incompletely excised BCCs, and ears (26 of 144 excisions [18.1%]) and forehead (20 of 157 [12.7%]) had the highest rates of incompletely excised SCCs. Of all BCC excisions, 67.3% were once-off excisions with no previous biopsy, and these excisions were more likely to be incomplete (odds ratio, 1.73; 95% confidence interval, 1.36-2.20) than those with a previous biopsy. There was, however, substantial variation in frequency of incomplete excision between clinics for BCC (ranging from 3.3% to 24.7%) and SCC (ranging from 0% to 17.2%) and between physicians within clinics (BCC ranging from 0% to 31.1%, and SCC ranging from 0% to 23.5%).
Overall frequency of incomplete excision is low and similar to that in other reports. However, high frequency in high-risk sites, low rates of previous biopsy, and substantial variation in performance between physicians and clinics suggests there is significant opportunity to further improve health outcomes.
研究澳大利亚对皮肤癌有特别兴趣的全科医生切除基底细胞癌（BCC）和鳞状细胞癌（SCC）不完全切除的比例。
记录回顾。
澳大利亚15家基层医疗皮肤癌诊所组成的网络。
2005年至2007年间，在澳大利亚15家基层医疗皮肤癌诊所组成的单一网络中，57名医生对9417例BCC和SCC进行了切除。
根据医生、诊所、病变的解剖位置以及是否进行过先前活检来统计不完全切除的比例。
6881例BCC中有443例（6.4%）和2536例SCC中有159例（6.3%）切除不完全。BCC和SCC在头颈部的不完全切除更为常见（分别为2872例切除中的282例[9.8%]和861例中的97例[11.3%]）。耳部（388例切除中的74例[19.1%]）和鼻部（546例中的78例[14.3%]）BCC不完全切除率最高，耳部（144例切除中的26例[18.1%]）和前额部（157例中的20例[12.7%]）SCC不完全切除率最高。在所有BCC切除中，67.3%是未进行过先前活检的一次性切除，这些切除比有过先前活检的切除更有可能不完全（比值比，1.73；95%置信区间，1.36 - 2.20）。然而，不同诊所之间BCC（范围从3.3%至24.7%）和SCC（范围从0%至17.2%）不完全切除频率存在显著差异，诊所内医生之间也存在差异（BCC范围从0%至31.1%，SCC范围从0%至23.5%）。
不完全切除的总体频率较低，与其他报告相似。然而，高危部位的高频率、先前活检率低以及医生和诊所之间的表现存在显著差异表明，有很大机会进一步改善健康结果。
