Surgery for the General Dermatologist

Background: Surgical treatment of Non-Melanoma Skin Cancer (NMSC) is undertaken with curative intent.The management of a clear margin may be straightforward but when the margin is close or frankly positive, it can be difficult to decide what to do.The key consideration in this situation is to understand the risk of tumour recurrence and the manoeuvres available to the treating clinician to reduce this.Objectives: An algorithmic approach would be beneficial to all specialties working in this space, particularly for clinicians working in community settings, particularly rural and remote.Methods: We have created an algorithm that assess the risk of skin cancer recurrence and attempt to modulate this with surgery or adjuvant therapies.It will provide a summary of our recommendations for the management of incompletely excised NMSCs based on a general literature review and evidence-based recommendations along with our own clinical experience.We will apply this algorithm to a dataset that contains de-identified information pertaining to patients who underwent NMSC excision under the Skin Lesion Assessment Management program (SLAM).Findings: There was no significant difference in disease free survival and rate of disease recurrence between those that favoured the algorithm and those that did not favour the algorithm.Conclusions: We were able to develop and validate an algorithm to assist in decision-making to control resection margins following excision of NMSC.