Excision of nonmelanoma skin cancer by a resident: how safe is it?

Abstract

Background

Nonmelanoma skin cancer (NMSC) is the most common skin cáncer worldwide. This study aimed to describe the differences in treatment, type of reconstruction, and outcome of nonmelanoma skin cancers (NMSCs) comparing residents to plastic surgeons within a university teaching hospital facility.

Methods

A retrospective study selecting all patients treated for NMSC during 1 year (2011) in an in/outpatient facility were performed. All patients were identified by DRG codes, DC44.0–DC44.9. Three groups of surgeons were compared to each other: (1) plastic surgeons, (2) residents, and (3) plastic surgeon with attending resident who was either supervised or assisting. All groups were stratified according to tumor stage and location.

Results

Plastic surgeons excised larger SCCs than residents (p = 0.03), while the size of BCCs were the same in all three groups (p = 0.6). No difference was found between the groups regarding complete excision rate (p = 0.9). Residents used direct suturing more frequently when compared to plastic surgeons (p < 0.001). For nasal reconstructions, flaps were applied more frequently when both grades of surgeons were operating together compared to residents (p = 0.044). The overall surgical time for excision and reconstruction of a T1–2 tumor was 30 (5–265) min. There was no difference when comparing plastic surgeons and residents in terms of surgical time. However, the surgical time was prolonged by more than 20 min when the two grades of surgeons were operating together. The overall complication rate was 7.5 % with no difference found between the groups (p > 0.05).

Conclusions

Preoperative patient selection by a consultant increases the patient's positive outcome, making NMSC excision a safe procedure regardless of surgeon grade.

Level of Evidence: Level III, prognostic-risk study