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Basal Cell Carcinoma – Information for GPs

Background

NHS Scarborough and Ryedale CCG (SRCCG) commissions’ healthcare on behalf of its local population across primary, secondary and tertiary care sectors. Commissioning policy including clinical referral pathways and thresholds have been developed and defined using appropriate NICE guidance and other peer reviewed evidence and are summarised here in order to guide and inform referrers.

This commissioning policy is needed in order to clarify the criteria for referral for Basal Cell Carcinoma.

Definition

The most common skin cancer. A locally invasive, slow growing type of skin cancer predominantly seen in Caucasians. Metastases are extremely rare.

Exclude red flag symptoms

Exclude melanoma and SCC

Management

Low Risk BCCs (<1cm, below clavicle)

  • Removal by accredited GP minor surgeon
  • Remove with 4mm margins, send for histology

High Risk BCCs (>1cm, under age 25, immunocompromised)

  • Above the clavicle; refer to Head & Neck
  • Around the eye; refer to Oculoplastic Clinic
  • >1cm, surgical complexity (e.g. on shin – skin flap may be required) or diagnostic uncertainty – refer to Dermatology

Superficial BCCs

  • Should be offered full range of medical therapies and may require referral to Dermatology

Remember – a thorough skin inspection should be undertaken once a BCC confirmed for other lesions

Investigations prior to referral

  • Low risk lesions should be managed as per the local guideline
  • Incomplete excisions should be referred to dermatology or discussed via the local Skin MDT

Information to include in referal letter

  • Size of lesion
  • Location of lesion (e.g. above clavicle)
  • Description of lesion
  • Past medical history
  • Drug history
  • Photograph of lesion

References

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