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Skin Lesion Excision Audit August 2013 – December 2013

Skin Lesion Excision Audit August 2013 – December 2013. Aims. To monitor – Number of skin lesions removed from August 2013 – December 2013 Excision margins (if requested, if commented on, and if complete or incomplete) Types of pathology

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Skin Lesion Excision Audit August 2013 – December 2013

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  1. Skin Lesion Excision AuditAugust 2013 – December 2013

  2. Aims • To monitor – • Number of skin lesions removed from August 2013 – December 2013 • Excision margins (if requested, if commented on, and if complete or incomplete) • Types of pathology • Number of patients requiring further interventions following initial histology report

  3. Suggestions from previous audit • Repeat audit cycle • Do all excision biopsies need to have excision margins requested? Decision for pathology? • Compare rate of margin reporting and extent of excision for malignant lesions with previous audits

  4. Method • Patients identified from theatre op book • Name & DOB • Surgeon • Type of op • Pathology reports on SCI store • Was excision margin requested? • Was excision margin commented on in report? • Lesion histology • If further action required SCI store document search

  5. Results • 32 operations identified from operation book • Two excluded – not skin lesions • 33 lesions excised from 30 patients • Two planned repeat operations

  6. Number of excisions by surgeon

  7. Types of histology

  8. Excision margins • Rate of margin request by surgeon • 13% (10% in previous audit) • 25% of malignant lesions (29% in previous audit) • Rate of margin reporting by pathologist • 63% (39% in previous audit) • 75% for malignant lesions (100% in previous audit)

  9. Excision margin extent • 33 lesions from 30 patients • 16 (48%) complete excision • 4 (12%) incomplete excision • 1 (3%) ‘probably complete’ excision • 12 (36%) no comment • 4 malignant lesions • 3 had margin reports • 3 incomplete excisions

  10. Excision margin extent Comparison of extent of excision of lesions between audit periods.

  11. Lesions requiring further action Of the 4 lesions incompletely excised... • 1 benign lipoma- • No further action • 1 SCC - • CT neck and thorax: NAD • Has been listed for repeat excision • 1 SCC – • CT neck and thorax: Marked thickening of the left pinna. Suspicion of invasion of the parotid gland. Borderline left Level IV lymph node (However, had OE at the time) • Awaiting FU this month +/- repeat CT • 1 BCC – • OPD 4/12

  12. Suggestions • Audit if ‘excision biopsy’ written in request. Is this adequate to prompt excision margins by pathology? • Repeat audit cycle

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