基层医疗中的基底细胞癌手术：当地全科医生能发挥作用吗？
Basal Cell Carcinoma Surgery in general practice: Is there a role for the local General Practitioner?
作者信息
Keah S H, Ng S C
机构信息
MBBS(S'pore), FRACGP, FAFPM, Elizabeth Medical Centre Muar, 1-14, Jalan Arab 84000 Muar, Johore, Malaysia, Email:
MBBS, MRCS (Edinburgh), GCFM, Elizabeth Medical Centre Muar, 1-14, Jalan Arab 84000 Muar, Johore, Malaysia.
出版信息
Malays Fam Physician. 2020 Nov 10;15(3):10-21. eCollection 2020.
UNLABELLED
Basal cell carcinoma (BCC) is a common disease of the skin caused principally by prolonged solar radiation exposure. It is normally a malignancy with favorable prognostic features and is potentially curable by standard excision. In White populations with high disease incidence, general practitioners (GPs) play a vital role in diagnosing and managing BCC, including surgical excision. Dedicated care at the primary care level by adequately trained GPs is conceivably cost effective for the health system and more convenient for the patient. In Asia and other parts of the world with low incidence, this valuable role of GPs may appear to be inconsequential. In this regard, any justification for the involvement of local GPs in BCC surgery is debatable. This article aims to provide a clinical update on essential information relevant to BCC surgery and advance understanding of the intricate issues of making a treatment decision at the primary care level.
CASE REPORT
Madam Tan, a 71-year-old Malaysian Chinese lady, otherwise healthy, presented to her local GP with a complaint of a nodule over the left cheek that had been there for more than a decade. Her concern was that the lesion was growing and had become conspicuous. She had spent most of her life as a farmer working in her orchard.Upon examination, she had an obvious dome-shaped nodule over the left cheek measuring approximately 1.8 cm in diameter. The lesion was firm, pigmented, well-demarcated, and slightly ulcerated at the top. Clinically, she was diagnosed with a pigmented nodular basal cell carcinoma of the left cheek. Examination of the systems was unremarkable.She requested that the consulting GP remove the growth. The cost for specialist treatment and waiting time at the local hospital were her concerns.
CLINICAL QUESTIONS
Can the basal cell skin cancer be excised safely and effectively in the local primary care setting? What are the crucial preoperative concerns?
未标注
基底细胞癌（BCC）是一种常见的皮肤疾病，主要由长期暴露于太阳辐射引起。它通常是一种预后良好的恶性肿瘤，通过标准切除有可能治愈。在疾病发病率高的白人群体中，全科医生（GPs）在诊断和管理基底细胞癌（包括手术切除）方面发挥着至关重要的作用。由训练有素的全科医生在初级保健层面提供专门护理，对于卫生系统而言可能具有成本效益，对患者来说也更便捷。在亚洲和世界其他发病率低的地区，全科医生的这一重要作用可能显得无关紧要。在这方面，当地全科医生参与基底细胞癌手术的任何理由都值得商榷。本文旨在提供与基底细胞癌手术相关的重要信息的临床更新，并增进对在初级保健层面做出治疗决策的复杂问题的理解。
病例报告
谭女士，一位71岁的马来西亚华裔女性，身体健康，因左侧脸颊出现一个已存在十多年的结节而就诊于当地的全科医生。她担心这个病变在长大且变得明显。她一生大部分时间都是在果园务农。经检查，她左侧脸颊有一个明显的圆顶形结节，直径约1.8厘米。病变质地坚硬，有色素沉着，边界清晰，顶部稍有溃疡。临床上，她被诊断为左侧脸颊色素性结节性基底细胞癌。系统检查无异常。她要求会诊的全科医生切除这个肿物。她担心当地医院专科治疗的费用和等待时间。
临床问题
在当地初级保健机构能否安全有效地切除基底细胞皮肤癌？术前的关键注意事项有哪些？
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