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| >> Media Section Below are press releases from July and August 2008. For any media queries, please contact Nina Goad, 0207 391 6355, nina@bad.org.uk To return to the main press release page, click here
Medical students receive inadequate training in one of commonest specialties, 03.07.08 1 in 17 under-16s using sunbeds, study reveals, 02.07.08
Statement in respone to Journal of Investigative Dermatology study findings that moisturizers increase skin cancer risk in UV-radiation treated mice (DOI: 10.1038/jid.2008.241) For immediate release, 14.08.2008
Nina Goad of the British Association of Dermatologists: “When it comes to skin cancer, mice are not reliable models for extrapolating what happens in human skin. If the theory that applying moisturisers increased the risk of non-melanoma skin cancers were correct, you would expect to see more of these cancers in women, and on their faces. This is not the case, so while the research is interesting, I don’t think any conclusions should be drawn from it at this stage, and it should not put people off using skin creams if they wish to do so.” Skin cancer audit show greater need for GP training GPs treating skin cancer patients should be given increased training and support, according to research due to be released at the British Association of Dermatologists annual conference in Liverpool last week.
Nine studies carried out at different hospitals across the UK found that skin cancers treated in primary care* were not done so appropriately, prompting calls for better compliance with national guidance.
There are three main types of skin cancer – basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Surgical excision is the treatment of choice for most skin cancers. If the cancer is not completely removed, this can lead to recurrence and further surgery, which can be technically more difficult and cause more scarring. Melanoma, the most deadly type, is more likely to spread if not completely removed.
The studies due to be presented indicate that some GPs do not have the technical competence to undertake this type of surgery safely. These studies have found that up to half of skin cancers are incompletely removed and the BAD is therefore anxious to ensure that quality of outcome for patients is identical no matter who undertakes the surgery.
Background For low-risk BCCs, the least deadly type of skin cancer, treatment can be carried out either in primary care by a doctor who is a member of the MDT, usually a GP with Special Interest (GPwSI) in dermatology, or in secondary care, usually by a dermatologist. However, any lesion that might be a high-risk BCC, an SCC or a melanoma, or where the diagnosis is uncertain, must be referred straight to a specialist - usually a dermatologist in secondary care. These cancers should not be treated by GPs. Nine local studies examined the number of skin cancer excisions taking place in the community, who by, and whether the cancers were completely excised and appropriately treated. All studies examined skin cancers treated in 2006 or 2007, predominantly after the publication of the NICE guidance. Skin cancer excisions – different types Four of the studies looked at excisions for more than one type of skin cancer. In an audit of BCC, SCC and melanoma specimens sent to Derbyshire Royal Infirmary over six months in 2007¹, 31 percent operated on in primary care were incompletely excised. Furthermore, none of the operations were performed by a GPwSI, or other member of the MDT. In the second study, reviewing excisions of all skin lesions in Sussex over two months in 2007², 14 percent of skin cancers were treated inappropriately in primary care, compared to just three percent in secondary care. In the third study, looking at biopsies for all three types of skin cancer sent to a teaching hospital in London over a three-month period in 2006³, 14 percent of tumours operated on by GPs should instead have been referred to hospital, owing to their high risk nature. A study of BCC and SCC excisions taken in primary care in Surrey4 over two months in 2007, revealed that a third were SCCs so should have been referred to a specialist. The remaining five studies looked at treatment of specific types of skin cancer, rather than biopsies of all cancerous lesions.
BCC Three studies focused on excisions of basal cell carcinomas. Collectively, these found that over a third of BCCs excised in primary care were done so incompletely. A team of researchers from Essex5 found that 46 percent of BCCs were incompletely excised by GPs in primary care compared to just six percent in secondary care dermatology. The findings were similar in a county-wide study of all BCC excisions carried out in 2006 in Cornwall6, where more than half (54 percent) of high-risk BCCs were incompletely removed in primary care, compared to just 11 percent in secondary care. According to NICE guidance, these skin cancers should have been referred from the outset. The results were not much better for low-risk BCCs, of which a fifth were incompletely excised in primary care compared to seven percent in secondary care. In the third study of BCCs, a sample of records from Norfolk and Lincolnshire was examined7. 22 percent were incompletely removed in primary care, compared to eight percent in secondary care. Dr Elisabeth Fraser-Andrews, one of the Essex study’s authors said: “The proportion of BCCs completely excised in primary care is low, showing that patients receive suboptimal treatment in primary care compared with secondary care. These findings support recommendations in the NICE guidance and Department of Health on provision of skin cancer treatment and indicate that it is imperative for GPs who wish to carry out surgical treatment of skin cancer in primary care to be adequately trained, audited regularly and accountable to a clinical governance structure.” This view was echoed by Dr Helena Malhomme de la Roche of the Cornwall study, who said: “The incomplete excision rates for patients with high risk BCC managed by GPs is unacceptably high at 54 percent. This audit validates some of the key recommendations of the NICE guidelines and poses the question of how to manage the large number of patients with BCC who are currently being treated by their GPs.” However, it is not just BCCs that are not being treated appropriately, which is why dermatologists are keen to highlight the NICE guidance to GPs, to help them with referrals of skin cancers.
SCC A study in Norfolk8 focused on 100 SCC cases and the length of time taken for the patient to be referred. Only 20 percent were referred via the two-week wait urgent route for suspected cancerous lesions, as per Department of Health guidance, and a quarter of these had already undergone a diagnostic surgical procedure in primary care. However, according to NICE guidance, these cancers should be referred straight to secondary care specialists.
Melanoma A further study in Norfolk9 found that over a six-month period in 2007, 80 melanomas – the deadliest types of skin cancer – were operated on in primary and secondary care. 13 percent of these were incompletely excised or biopsied in primary care. Furthermore, of those that were incompletely excised or biopsied, 60 percent were suspicious of melanoma at the time of operation, based on their symptoms.
Dr David Shuttleworth, Clinical Vice-President of the British Association of Dermatologists, said: “These audits show that skin cancers can be extremely difficult to diagnose and treat, so it makes sense that GPs who wish to treat skin cancers should receive increased training and support. “The NICE guidance simplifies the process by allowing all high risk BCCs and other skin cancers to be referred straight to specialists. However, the guidance has not been widely publicised so many doctors may not be aware of its existence.”
The guidance was published in February 2006 and measures to ascertain compliance are expected to be introduced later this summer. Trusts and PCTs will be expected to fully conform to the guidance within six months of publication of these measures. However, from the date of the guidance’s initial publication in 2006, healthcare providers should have been working towards adhering to the guidance.
-Ends
If using this study, please ensure you mention that the study was released at the British Association of Dermatologists’ Annual Conference. *‘Primary care’ refers to health services in the community, such as GPs, which are usually the first port of call for patients, who can then be referred on to ‘secondary care’, which defines medical professionals who are usually based in a hospital. In these audits, secondary care refers to hospital specialists, e.g. Consultant Dermatologists. (1)National Institute for Health and Clinical Excellence “Improving Outcomes for People with Skin Tumours including Melanoma”, February 2006. 1. All BCC, SCC and melanoma samples taken in primary care, July – Dec 2007, and sent to Derbyshire Royal Infirmary. For more information please contact Nina Goad, Communications Manager, Phone: 0207 391 6355 (office) , Email: nina@bad.org.uk, Website: www.bad.org.uk
Medical students receive inadequate training in one of commonest specialties For immediate release July 3rd 2008 Medical students feel that they are receiving inadequate training in a common specialty, a new study has revealed. More than half of medical students regard their level of education in dermatology as insufficient, and many do not feel confident in diagnosing or treating skin diseases, according to research presented at the British Association of Dermatologists’ annual meeting this week.
This worrying shortcoming is despite dermatology comprising a large proportion of the overall NHS workload. Dermatology includes more than 1,000 diseases of the skin, hair and nails, and eight million people in the suffer from a skin disorder. One in five children suffer from eczema.
The number of people seeking help from their GP for skin diseases is increasing, and GPs now spend about 15 percent of their consultations dealing with skin problems.* In fact, skin disorders are the third commonest reason for a person to seek help from their GP.
As dermatology is integral not only to consultants but also to GPs and other medical professionals, a team of researchers from Liverpool, Manchester and Oxford carried out a survey of 449 final year medical students from 14 medical schools. The survey specifically focused on educational methods and confidence levels within each of 54 important learning outcomes that should be achieved by all medical graduates, as identified by a national panel in 2006. **
56 percent of respondents stated that the level of undergraduate training in dermatology was insufficient. Half did not feel confident in treating skin disease patients. Furthermore, a third did not even feel adequately confident in assessing or diagnosing skin diseases in the first place.
Students who received teaching from dermatologists, dermatology specialist nurses and expert patients reported significantly higher levels of confidence.
Dr Yi Zhen Chiang from the Royal Liverpool University Hospital, who presented the research, said: “This survey has identified the methods that best improve medical student confidence in the practice of dermatology. These results will hopefully contribute to an understanding of how the delivery of dermatology education in the undergraduate course can be improved.”
President of the British Association of Dermatologists Dr Mark Goodfield said: “This study reveals a worrying lack of confidence in medical students with regards to dermatology, which is one of the most common reasons for people to consult their doctor.
“Students reported that practical learning was beneficial, so it would be good to see a higher proportion of the training curriculum dedicated to this type of learning.”
Ends * Royal College of General Practitioners Curriculum Statement 15.10
One in 17 under-16s use sunbeds, study reveals For immediate release July 2nd 2008 A survey of secondary school children in the West Midlands has revealed a worrying level of sunbed use in under-16s. The study, due to be presented at the British Association of Dermatologists Annual Conference in Liverpool this week, asked 872 children at a secondary school in Dudley, West Midlands about their UV exposure. All of the children were aged between 11 and 16. Despite their young age, six percent had used an artificial tanning device. 70 percent of these were girls. A quarter reported that they sun burnt easily and 30 percent had freckles, yet still used a sunbed. However, this was not predominantly one-off use. 18 percent of those who used sunbeds did so at least once a week, while a further 41 percent used a sun bed at least once every three months. Nearly half of the devices used were coin-operated. The majority of sun beds were located at tanning salons, although a significant number were home devices or at public gymnasia. Furthermore, 12 percent of those who had used a sunbed had a family history of skin cancer. 92 percent had at least one family member using sun beds. Results for all 872 children demonstrated that they spent on average two hours per day in the sun during the summer on a weekday, and three hours per day on weekends. An average of 14 days a year was spent on sunny holidays, with a median of five hours per day sun exposure. However, the children who used sunbeds also had a higher exposure to outdoor sunshine in the and on sunny holidays. Dr Ravi Suchak, dermatologist at Barts and the London NHS Trust and one of the researchers, said: “Our findings indicate that a significant number of schoolchildren use artificial tanning devices. Moreover, a significant proportion of them is fair skinned and has higher than average exposure to outdoor sunshine. “Tougher licensing and regulation of tanning salons, and a restriction on un-staffed, coin-operated devices is overdue. Most users have family members who use sun beds and so health education of the population as a whole on the hazards associated with sun beds and overall excessive UV exposure should continue to be a high priority.” President of the British Association of Dermatologist Dr Mark Goodfield said: “This study illustrates why we need proper licensing of the sunbed industry. Children of this age should not be able to access sunbeds in salons or gyms. “Too many sunbeds are unsupervised, so children can use these devices as many times as they like, putting themselves at risk of developing skin cancer. “We would like to see a ban on all coin-operated sunbeds, as well as the removal of sunbeds from gyms and other venues that can give the impression they are healthy. Furthermore, there needs to be better information on display about the health risks, as many salons fail to provide this.” Mrs. Anna Pinto, Science Director at The Kingswinford School where the study was conducted said: “The use of sunbeds in the under 16’s has become a growing concern and as a Science College we were delighted to assist with this research project.” Ends Notes to editors: For more information please contact Nina Goad , Communications Manager, Phone: 0207 391 6355, Email: nina@bad.org.uk, Website: www.bad.org.uk Study details: Exposure to artificial tanning devices by young teenagers at a science college in Dudley , West Midlands . Ravi Suchak (1), Anna Pinto (2), Julie Devlin (2), Peter Limb (2), Rino Cerio (1); Barts and the London NHS Trust, London, United Kingdom (1); Kingswinford School , Dudley , West Midlands , (2)
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