Skin Cancer Clinical Advisory Group – Information for CAG Members

COVID-19 Management Plans
Skin Cancer Management Guidance in Response to COVID
Dermatology COVID 19 surgery procedures v3
http://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=6658

Skin Cancer CAG Key Documents:
These are living documents that will be continually reviewed and updated.
Please refer to the version control table to see the current status.
SWAG_Skin_Cancer_Clinical_Guidelines_2022 (review underway)
SWAG_Skin_Cancer_Constitution_2022 (review underway)
Management_of_Palpable_Node_in_ Skin_Cancer
Transplant_Skin__Clinic_Surveillance_Visit
Renal_Transplant_Baseline_Dermatology_Risk_ Assessment

Bristol Mohs Micrographic Surgery Service:
SWAG Bristol Mohs referral contact details v1.2
SWAG Bristol Mohs Guidelines text v1.2
SWAG Bristol BCC and Mohs Guidelines flowchart v1.2
Bristol_Mohs_Patient_Information_Leaflet v1.5

Update on Bristol and SWAG Mohs Micrographic Surgery service – July 2022

Dear Colleagues,

I am delighted to inform you that the Bristol Mohs service is back up to 3 surgeons i.e. operating 3 days per week again. The Mohs surgeons as before are me, and Dr Kimberlee Lim. I would also like to introduce you to our new colleague Dr Nina Natafji. Nina has recently joined us from her Mohs fellowship in Addenbrooke’s, Cambridge, following training at various prestigious UK centres, so we are delighted that she has chosen to join our team.

We are therefore steadily chipping away at the waiting list such that it has reduced so far to around 6 months for routine cases. What this means for you is probably not a dramatic change of practice but perhaps a change of the balance of your discussions with your patients. You may wish to consider referral for somewhat borderline cases, that may benefit from Mohs, but you had been managing without during the main pandemic phase.

As ever we would always encourage referral for the scenarios below.

Yours faithfully,

Adam Bray

Dr Adam Bray MBChB FRCP(UK) Derm

Consultant Dermatologist

Dermatological & Mohs Surgeon

Southmead Hospital, North Bristol Trust

Bristol Dermatology Centre, University Hospitals Bristol & Weston NHS Foundation Trust

Strongest indications for Mohs:

Primary BCC threatening important anatomy (or position limits reconstruction options)
Poorly defined edges/infiltrative BCC in H zone of face

Any incompletely excised BCC in H zone of face
Any head/neck BCC incompletely excised more than once (including once by experienced skin cancer surgeon)
Re-excision with wide margins will be excessively disfiguring or force unsatisfactory reconstruction/delayed repair
Rarer aggressive infiltrating tumours in the H zone e.g. MAC

Also consider Mohs for:

Any BCC where delayed repair is considered

Well-defined primary nodular BCC on lower third of nose
Well-defined primary nodular BCC on lower eyelid but away from lacrimal punctum
Primary infiltrative BCC on face/scalp but away from H zone and well-defined edges

Other tumours

Many follicular/appendageal tumours can be treated with normal fresh frozen Mohs (if meeting the same sorts of indications as BCCs)

We do not currently treat DFSP with Mohs in Bristol (neither fresh frozen or paraffin fixed). However colleagues in other centres do (e.g. London -St John’s) so do consider it. Some colleagues have asked us to look into developing a Bristol service, so if you feel this may be useful please let me know, or if you refer elsewhere and are happy that would also be helpful to know)

We do not currently treat Lentigo Maligna with Mohs, but we can offer peripheral margin-controlled excision of Lentigo maligna (or LMM) with paraffin fixed tissue (similar to Mohs i.e. ‘spaghetti technique’) where tissue sparing or clearance is important and delayed repair is being considered.

Best email for advice: adam.bray@nbt.nhs.uk

Archived update from February 2021 is available on request: helen.dunderdale@uhbw.nhs.uk

Research:
Clinical Trials 2019

Useful Links:
The West of England Clinical Research Network
http://www.crn.nihr.ac.uk/west-of-england/

The Somerset Cancer Register (SCR)
http://nww.cancerreg.somersethis.nhs.uk/default.aspx

The National Cancer Research Institute Clinical Studies Group (NCRI) – Portfolio Maps
http://csg.ncri.org.uk/portfolio-maps/