Histological analysis of all scalp cysts is counsel of perfection
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3847 (Published 01 June 2012) Cite this as: BMJ 2012;344:e3847
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I entirely agree with the views of Khan et al.that every scalp lesion should be submitted for histology and a precise diagnosis established. There is no room for a single error in diagnosis of malignancy, irrespective of its incidence. The economic climate of NHS should not be allowed to cloud the appropriate diagnosis and treatment of patients. General practice is very much suffering from this misconception, and a "penny wise and pound foolish" approach seems to be being adopted by several general practices that I am aware of. Long-term benefit and quality of life for every single patient are paramount, but this is being ignored in general practice.
Should minor surgery be allowed to be performed by general practitioners? This in itself is an issue from my own personal experience, because the long-term hazards to patients do not justify general practitioners undertaking even minor surgery. The difference between a professional surgeon and a technician is significant when a patient has to go under the knife, however minor the surgery may be, which is based on my own personal experience as a patient. I would recommend every lump or a lesion excised from a patient should be submitted for histology and the procedure should be undertaken by appropriately trained and certified doctors with relevant qualification rather than by a general practitioner.
Competing interests: No competing interests
Re: Histological analysis of all scalp cysts is counsel of perfection
I agree with the view of Khan et al. and Badri M Shresth that all scalp lesions should have histology performed to establish an accurate diagnosis; in fact I think it applies to all patients with injuries treated by minor surgery, like Badri M Shrestha says: "There is no place for a single error in the diagnosis of malignancy, regardless of its impact".
But I disagree with your assertion that minor surgery may not be performed by a general practitioner. In the literature there are few studies on minor surgery in primary care, but there are good aesthetic results that show, user satisfaction, a good clinicopathologic correlation and lower cost than the same procedures performed at hospital level, even if there are some publications that express doubts about the quality of minor surgery in primary care, which are based on a lack of training and low volume of minor surgery in primary care (George S, Pockney P, Primrose J, Smith H, Little P, Kinley H, Kneebone R, Lowy A, Leppard B, Jayatilleke N, McCabe C. A prospective randomized comparison of minor surgery in primary and secondary care. The Mystic trial Source Public Health Sciences and Medical Statistics, University of Southampton School of Medicine, UK Health Technol Assess. 2008 May, 12 (23): iii-iv, ix-38).
I work in a primary care centre where minor surgery has been performed for 9 years, with about 1800 interventions and good aesthetic results, user satisfaction, a good clinicopathologic correlation and significant cost savings of more than 50% compared to hospitals; all the injuries with surgery had samples sent for histology in pathology departments. In the minor surgery service we have three trained doctors, who perform minor surgery with excellent results, so I think that minor surgery should be performed by trained physicians, general practitioners or not.
Competing interests: No competing interests