Guide to shave procedures in general practice.

BACKGROUND: General practitioners manage a significant proportion of inflammatory and neoplastic skin conditions on a daily basis. Various surgical techniques can be employed to aid in diagnosis, including punch biopsies, shave biopsy, shave excision, incisional biopsy, curettage and formal excision with closure. Requiring minimal equipment, shave procedures are quick to perform, produce good cosmetic outcomes and minimise costs. OBJECTIVE: Our aim is to discuss shave procedures in detail and highlight the difference between shave biopsies and shave excisions, as well as the role they each have in diagnosing an array of benign, inflammatory and malignant skin conditions, including melanocytic lesions. DISCUSSION: Shave procedures performed on suitable lesions by trained practitioners can be used for sampling or removing suspect lesions. Where the intent is complete removal, margin involvement is rare given good lesion selection and technique.

Development of melanoma clinical quality indicators for the Australian melanoma clinical outcomes registry (MelCOR): A modified Delphi study.

BACKGROUND: Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty-six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. METHODS: Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two-round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. RESULTS: Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. CONCLUSION: This study provides a multi-stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).

A guide to curettage and cautery in the management of skin lesions.

BACKGROUND: Curettage and cautery is a procedure used for treatment of low-risk skin malignancies and pre-cancerous lesions. Given good lesion selection and technique, high cure rates and good cosmesis are routine for this quick, simple and cost-effective operation. OBJECTIVE: The purpose of this article is to review and summarise the steps in managing carefully selected cutaneous lesions with curettage and cautery. DISCUSSION: This article will address lesion selection, technique, efficacy, complications and how to incorporate curettage into daily practice.

Recognising skin manifestations of rheumatological disease.

BACKGROUND: An understanding of skin conditions associated with rheumatic diseases ensures accurate diagnosis and management. Cutaneous manifestations of rheumatological disease are legion. OBJECTIVE: The aim of this article is to increase clinician familiarity with the dermatological manifestations of rheumatic conditions to enable accurate diagnosis and effective management. DISCUSSION: This article will address the skin manifestations of lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, dermatomyositis and scleroderma, including their implications in diagnosis, prognosis and treatment.