Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2014; 41(05): 500-504
DOI: 10.5999/aps.2014.41.5.500
Original Article

When Are Circular Lesions Square? A National Clinical Education Skin Lesion Audit and Study

Benjamin H Miranda
Plastic and Reconstructive Surgery Department, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
,
Katie A Herman
Plastic and Reconstructive Surgery Department, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
,
Marco Malahias
Plastic and Reconstructive Surgery Department, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
,
Ali Juma
Plastic and Reconstructive Surgery Department, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
› Author Affiliations
› Further Information
   Permissions and Reprints

Background Skin cancer is the most prevalent cancer by organ type and referral accuracy is vital for diagnosis and management. The British Association of Dermatologists (BAD) and literature highlight the importance of accurate skin lesion examination, diagnosis and educationally-relevant studies.

Methods We undertook a review of the relevant literature, a national audit of skin lesion description standards and a study of speciality training influences on these descriptions. Questionnaires (n=200), with pictures of a circular and an oval lesion, were distributed to UK dermatology/plastic surgery consultants and speciality trainees (ST), general practitioners (GP), and medical students (MS). The following variables were analysed against a pre-defined 95% inclusion accuracy standard: site, shape, size, skin/colour, and presence of associated scars.

Results There were 250 lesion descriptions provided by 125 consultants, STs, GPs, and MSs. Inclusion accuracy was greatest for consultants over STs (80% vs. 68%; P<0.001), GPs (57%) and MSs (46%) (P<0.0001), for STs over GPs (P<0.010) and MSs (P<0.0001) and for GPs over MSs (P<0.010), all falling below audit standard. Size description accuracy sub-analysis according to circular/oval dimensions was as follows: consultants (94%), GPs (80%), STs (73%), MSs (37%), with the most common error implying a quadrilateral shape (66%). Addressing BAD guidelines and published requirements for more empirical performance data to improve teaching methods, we performed a national audit and studied skin lesion descriptions. To improve diagnostic and referral accuracy for patients, healthcare professionals must strive towards accuracy (a circle is not a square).

Conclusions We provide supportive evidence that increased speciality training improves this process and propose that greater focus is placed on such training early on during medical training, and maintained throughout clinical practice.

Keywords

Clinical audit - Skin neoplasms - Education - Study - Surgery, plastic


Publication History

Received: 24 April 2014

Accepted: 09 June 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA