23-05-2025
GPs Urged to Improve Skin Cancer Care with Dermoscopy
BIRMINGHAM — Primary care professionals were urged to use dermoscopy and consider further training in minor skin surgery during the Primary Care Show 2025, amid a sharp rise in skin cancer cases across the UK.
Speaking at the event, dermatology clinical nurse specialist Julie Van Onselen said skin cancer has been called 'the new epidemic of healthcare'. She encouraged GPs to be more proactive in identifying and managing skin lesions.
A Growing Health Burden
Recent data show there were 224,092 cases of skin cancer recorded in England in 2019. Of these, 15,332 were melanomas. Of the 208,760 non-melanoma skin cancer (NMSC) cases, 74% were basal cell carcinomas (BCCs), 23% were squamous cell carcinomas (SCCs), and 2% were rarer types of skin cancer.
Cancer Research UK data show the highest incidence rates are among older adults. More than a quarter (29%) of new melanoma cases in the UK and 48% of new NMSCs occurred in individuals aged 75 and over.
Clinical Vigilance in Primary Care
'We have to recognise all skin cancers early and treat them,' Van Olsen said. 'Particularly for melanoma, which is 4% of all new skin cancers and the fifth most common cancer now in the UK. If you can recognise an early melanoma, you can save lives – and that's what's so important.'
Van Olsen added that all primary healthcare professionals 'have a responsibility to be able to assess skin and particularly be alerted to any lesion of concern that we should then discuss with a colleague, or think about referral'.
There were many skin changes that did not necessarily require medical attention but could bother a patient enough for them to ask their clinician about it. This might happen as an aside remark from a patient as they walked out of the door, Van Olsen told Medscape News UK .
'Even though dermatology is seen to be a specialist field, it's not. It's a generalist subject because for 20% of people who come for primary care consultations, it's skin related,' she said.
'When you examine somebody who comes in with a lesion, the first thing you need to do is take a really good clinical history. You need to examine, and one of the key things is that it's not really good enough just to look at the actual mole or the changing lesion. You need to try and examine as much of the skin as possible.'
Dermatoscopes: A Key Diagnostic Tool
Van Olsen, who has been working in the dermatology field for more than 30 years and is executive committee member of the Primary Care Dermatology Society (PCDS), encouraged healthcare professionals to learn dermoscopy if this was not already part of their skillset. 'It will really help you recognise normal lesions and detect lesions of concern, early,' she said.
A dermatoscope 'is as useful a tool to the skin as the stethoscope to the chest, the auroscope to the ear, and the ophthalmoscope to the eye,' she said. 'I think everybody — every healthcare professional in primary care — should use one.'
Dermoscopy enables a much more thorough evaluation of the skin, right down into the dermal layer. For those not familiar with using a dermatoscope, Olsen recommended referring to the guide published on the PCDS website and information on the society's YouTube channel . The PCDS also runs a course for beginners.
Recognising Red Flags
Among 'red flags' for skin lesions are rapid growth, pain or soreness, and bleeding. Look for recent changes in the size, shape, and symmetry of the lesion, Van Olsen advised.
If a lesion 'wobbles, it's soft, it squishes', blanches, or looks like it has a crumbly and rough surface, then it could be benign.
Asymmetry, irregular borders, and multiple colours are warning signs for melanoma. 'I sometimes say to patients, if your mole was a pizza and we cut it in four and all your friends got the same slice, we'd be happy. If they all got different toppings, that would mean the pattern would not be symmetrical,' she told her audience at the meeting.
The A in 'asymmetry is the first component of the ABCDEF lettering system for recognising possible melanoma.
B stands for border, with irregularity being concerning; C is for colour, where three or more colours are a worry; D is for diameter, where a lesion larger than 6 mm is suspect, and E if for evolving, meaning there is growth or change.
F stands for 'funny looking'. Be on the lookout for the 'ugly duckling sign': anything that is out of the ordinary or looks unusual to you, even if the patient indicates that nothing had changed, Van Olsen advised.
Also in use is the EFG system, standing for elevated, firm, and growing. All of these factors need to be present for the lesion to be considered concerning.
'If in doubt, check it out', Van Olsen stressed.
Expanding Skin Surgery in Primary Care
Delegates also heard from Dr Miles Scholar, who highlighted the potential for GPs to perform minor skin surgeries, such as removal of low-risk BCCs.
Dr Miles Scholar
'We're drowning in skin cancer in this country now,' noted Scholar, a senior GP partner at Witley and Milford Medical Partnership in Witley and associate specialist plastic surgeon at The Royal Surrey County Hospital in Guildford.
'Everybody's waiting lists are crammed, and quite regularly we are seeing patients wait from 9 to 12 months to have the surgery for basal cell carcinoma,' he told Medscape News UK .
Scholar observed that unlike melanoma or SCCs, BCCs tend to be slow growing. However, if untreated, they can become destructive and require complex surgery.
Scholar called for a streamlined process to allow surgically inclined GPs to manage low-risk BCCs. This would 'relieve that pressure on the hospitals so they can concentrate on the more difficult things, like the squamous cell carcinomas, the melanomas, and the rare skin tumours, which obviously need a lot more input'.
Mixed Support from Secondary Care
While some secondary care providers were likely to be open to GP involvement, support from trusts was 'patchy', Scholar admitted.
He attributed resistance to skin tumour guidelines from the National Institute for Health and Care Excellence which were published almost 20 years ago. At that time, it was not recommended for GPs to be operating on skin cancer.
However, he believes the landscape is changing. 'There is a perception that certainly these low-risk skin tumours, like basal cell carcinoma, can be dealt with by GPs safely, as long as [the BCCs] fulfil certain criteria and the GPs themselves are adequately trained and regulated.'
'There's more than enough for everybody to do,' he added, noting that the NHS is 'a collaborative organisation – so, seeing ways that everybody can improve the nation's health, overall, is important'.
Van Onselen and Scholar declared no conflicts of interest.
