IS HISTOLOGICAL EXAMINATION OF TISSUE REMOVED BY GENERAL-PRACTITIONERS ALWAYS NECESSARY - BEFORE AND AFTER COMPARISON OF DETECTION RATES OFSERIOUS SKIN-LESIONS

Objectives: To examine whether histological examination of all tissue removed by general practitioners in minor surgery increases the rate o f detection of clinically important skin lesions, and to assess the im pact of such a policy on pathologists' workload. Design: Before and af ter comparison. Setting: Stratified random sample of 257 general pract itioner partnerships from the catchment areas of 19 English pathology laboratories. Subjects: Tissue removed in minor surgery by general pra ctitioners during the control period (September 1992 to February 1993) and intervention period (September 1993 to February 1994). Interventi on: General practitioners referred to their local pathology laboratory all solid tissue removed in all minor surgery, irrespective of their previous policy. Main outcome measures: Numbers of specimens referred for histology by general practitioners during intervention and control periods; numbers of primary malignant melanomas, non-melanoma maligna ncies, premalignant lesions, and benign lesions. Results: 257/330 part nerships participated (response rate 78%). During the intervention per iod 5723 specimens were sent, compared with 4430 during the control pe riod. The referral rate increased by an estimated 1.34 specimens per 1 000 patient years (95% confidence interval 0.93 to 1.76, P<0.001). Gen eral practitioners sent 204 specimens that were malignant (including 1 6 malignant melanomas) in the control period and 188 that were maligna nt (including 15 malignant melanomas) during the intervention period ( change in total number of malignancies, -1.0 per 100 000 patient years (-5.9 to 3.8, non-significant). Conclusions: The intervention was ass ociated dth a substantial increase in laboratory workload, all of whic h was accounted for by increases in non-serious lesions. This observat ion should be taken into account when considering the merits of a poli cy requiring histological examination in every case.