Members frequently notify College that they have referred a patient for difficult skin cancer care only to be dissapointed by the substandard, inappropriate or unproven approaches that are used by those managing the patient.
Examples commonly quoted include:
- Treating nodular BCC with imiquimod (Aldara)
- Treating keratoacanthoma with intralesional methotrexate
- Treating nodular or difficult BCCs with curettage and no surgical margin
- Very narrow margin excision of facial tumours
- Invariably pushing new melanoma patients to have sentinel node biopsy
- Not re-operating on positive margins following excision
- Blunderbuss investigations including scans for new melanoma patients
- Using diathermy every time they use the curetteÂ
- "They either don't or can't use a dermoscope"
- Not understanding sub types of BCC and subsequent variation in management
- Never considering systematic approaches like Mohs or DCÂ for tough face BCCs
- Using skin topical treatments on mucosa (usually pink lip)
- Using 5 fluro uracil topical for superficial BCCs
Should you find you are referring patients to someone and these sorts of poor management are happening, - refer to someone else!
We DO have a problem with many so called experts either not understanding or not effecting quality skin cancer management.
But there are others who are good at this health care subspecialty. Refer to them instead.
Remember that all ACSCM Fellows regularly accept referrals for skin cancer management and many of our Diplomats are also happy to accept referred patients.
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