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Reporting of Skin cancer using RCPath Standards. A regional perspective.

Reporting of Skin cancer using RCPath Standards. A regional perspective. Paul Barrett. Aim. Determine if RCPath standards have been adopted Part of network clinical guidelines (Jul13) RCPath Oct12 (revised May14) Pathology can be critical in determining cases to be discussed at MDT

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Reporting of Skin cancer using RCPath Standards. A regional perspective.

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  1. Reporting of Skin cancer using RCPath Standards. A regional perspective. Paul Barrett

  2. Aim • Determine if RCPath standards have been adopted • Part of network clinical guidelines (Jul13) • RCPath Oct12 (revised May14) • Pathology can be critical in determining cases to be discussed at MDT • Excisional intent • High risk • Incompletely excised

  3. Planned high quality cancer care to just over 3 million people in the North of England • 8 Foundation and 1 NHSTrusts • 14 Primary Care Trusts (PCTs) • 5 localities

  4. Method • 25 reports requested from 2014 • Each cancer type • Each centre reporting in North East • Core items in RCPath guidelines assessed • One centre failed to submit by deadline • Not all cases suitable • Not all sites had 25 cases

  5. Melanoma • Fairly established dataset • No major changes

  6. Results - Melanoma • 101 cases • Local MDT • 31 • Proforma • 75 • Non-proforma • 4 central (6%) • 22 local (71%)

  7. Results - Melanoma • All cases • Macroscopic description skin ellipse • Macroscopic description lesion • Excision margins

  8. Results - Melanoma Critical results • Breslow 1 (1/0) • Clark’s 6 (5/1) • Ulceration 7 (7/0) • 12 cases do not include vital data • All destined for review

  9. Results - Melanoma • LVI 5 (5/0) • PNI 11 (11/0) • Microsat 52 (22/30) • Subtype 13 (12/1) • Growth phase 9 (9/0) • Stage 21 (18/3)

  10. Results - Melanoma • Mitotic rate 2 (2/0) • Regression 17 (15/2) • TiL 14 (14/0) • All data items provided 47 (46%)

  11. SCC • Significant change around risk status • Complexity with pT2 • Any two of • Poor differentiation • Into subcutaneous tissue • >2mm • Into reticular dermis

  12. Results - SCC • 126 cases • Local MDT • 52 (41%) • Proforma • 63 (all central) • Non-proforma • 11 central (17%) • 52 local (82%)

  13. Results - SCC • All cases • Macroscopic description skin ellipse • Macroscopic description lesion • Excision margins

  14. Results - SCC Critical results • Grade 8 (8/0) • Thickness 10 (10/0) • Level 32 (30/2)

  15. Results - SCC • LVI 7 (7/0) • PNI 22 (22/0) • Subtype 47 (47/0) • Risk 86 (54/32) • Stage 65 (41/24)

  16. Results - SCC • Correct assessment of risk • Recorded in 40 • 3 incorrect • 2 insufficient data in report to assess • All data items provided 25% • 32 cases (2/30)

  17. BCC • Established data set • Is it really cancer? • Multiple specimens common

  18. Results - BCC • 159 cases • Local MDT • 86 (54%) • Proforma • 65 (all central) • Non-proforma • 8 central (17%) • 86 local (100%)

  19. Results - BCC • All cases • Macroscopic description skin ellipse • Macroscopic description lesion

  20. Results - BCC Key results • Growth pattern 1 (1/0) • Level 57 (56/1) • Margins 2 (1/1)

  21. Results - BCC • LVI 28 (27/1) • PNI 15 (14/1) • Risk 85 (85/0) • Stage 92 (68/24) • All data items provided 26% • 41 cases • Combination risk and/or stage absent

  22. Recommendations • Data could be derived • Melanoma review centrally • Confirms value in reporting by proforma • College KPI • Ensure proforma contains all core items • Re-audit or audit locally

  23. Questions?

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