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Basal cell carcinoma: are early appointments justifiable?
P M Gordon1, N H Cox, W D Paterson
1Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, U.K.
The British Journal of Dermatology
|March 29, 2000
Summary
Routine urgent referrals for suspected basal cell carcinoma (BCC) may not be necessary. Our study indicates that the slow growth of BCC means reducing referral times has minimal impact on tumour size, suggesting urgent referrals are not routinely required.
Area of Science:
- Dermatology
- Oncology
- Public Health Policy
Background:
- Patients with suspected skin tumors in the U.K. are typically referred to dermatologists by general practitioners.
- The urgency of these referrals is a significant political and healthcare policy consideration.
Purpose of the Study:
- To evaluate the necessity of routinely urgent referrals for basal cell carcinoma (BCC).
- To determine if current referral urgency guidelines are supported by clinical evidence regarding BCC growth and size.
Main Methods:
- Retrospective analysis of case records from 162 patients diagnosed with basal cell carcinoma (BCC).
- Statistical analysis to assess correlations between tumour size, patient age, duration of BCC, and referral-to-consultation interval.
- Modeling BCC growth to estimate the impact of reduced referral times on tumour size.
Main Results:
- The average BCC size was 7.4 mm, with a mean duration of 20.5 months.
- No significant correlation was found between tumour size and patient age, tumour duration, or referral interval.
- A reduction in referral interval to the government target of 2 weeks would result in a therapeutically insignificant change (0.7 mm) in average BCC size.
Conclusions:
- Current evidence suggests that routine urgent referrals for basal cell carcinoma are not necessary for the majority of patients.
- While individual cases with rapid growth or concerning features may warrant urgent assessment, the general slow growth rate of BCC does not support a blanket urgent referral policy.
- Healthcare policies regarding referral urgency for BCC should be evidence-based, considering the actual clinical significance of potential size differences.