598
Correspondence
hospital based nature of our surve:y,and most of the nonneoplastic and benign lesions identified were of little significance in their own right. Nevertheless, the lack of correlation between the clinical innpression and the true histopathological diagnosis suggests that, if such apparently trivial lesions are discarded important clinical conditions will be missed in a significant proportion of cases (in our study, between 1.7’ and 14.8%). Recent studies suggest that this proportion may be higher in the hands of general practitioners2 and further reinforces Cotton and Stephenson’s contention that routine histopathology of these and other similar lesions is necessary. As they suggest we, as histopathologists, should be informing our clinical colleagues of the value of clinicopathological correlation in training and audit at all possible opportunities. C.M.Manson R .F.T.McMahon Division of Histopathology, Department of Pathological Sciences, University of Manchester, Stopford Building, Oxford Road, Marichester M 1 3 9PT, UK
References 1 . Cotton DWK, Stephenson TJ. Histopathology for minor surgery. Histopathology 1992: 20: 455-456. 2. McWilliam LJ. Knox F, Wilkinson N, (logarah P. Performance of skin biopsies by general practitioners. Br. Med. 1. 1991: 303: 1 1 771179.
Sir: Presumably due to unfortunate timing, possibly the most important reference relating to minor surgery in general practice has not been included by Drs Cotton and Stephenson’. This comprises the recent guidelines issued by The General Medical Services Committee and The Royal College of General Practitioners’. Here, it is 6rmly stated that ‘all lesions removed during minor surgery should be sent for histological examination’. This is fortunate as, ironically, a different Sheffield University department has seriously queried the ‘expensive and time consuming option of sending all specimens for histopathological e ~ amin atio n ’~ This . view, however, does emphasise that we cannot forget the new ‘internal market’ and that general practitioners will be looking for the most cost-effective laboratory to report their specimens. Also, the guidelines and the general practitioner’s ‘red h a n d b ~ o kserve ’ ~ as timely reminders that, to date,
minor surgery histopathology has not been viewed on the same scale of importance as, for example, the national breast and cervical cytology screening programmes. The clinical importance of melanocytic lesions alone, makes this illogical in view of the rising incidence of melanoma and the necessity to correctly diagnose and treat early melanoma and its precursors. It is revealing that the only collaboration acknowledged in the guidelines is that with The Royal College of Surgeons. Similarly, perusal of the minor surgery list in the ‘red handbook’ suggests minimal histopathological contribution to its national formulation. It would appear imperative, as emphasized by Drs Cotton and Stephenson, that this situation is improved by histopathologists assuming a higher profile. D.Slater Department of Histopathology, Rot herham District Hospital, Moorgate Road, Oakwood, Rotherham S60 2UD, UK
References 1 . Cotton DWK, Stephenson TJ.Histopathology for minor surgery. Histopathology 1992: 20: 455-456. 2. Minor Surgery in General Practice. Guidelines by The General Medical Services Committee and The Royal College of General Practitioners. Department of Health. 1991: 1-5. 3. Brazier JE, Lowy A. Performance of skin biopsies by general practitioners. Br. Men. 1. 1991: 303: 1472. 4. Statement of fees and allowances. National Health Service General Medical Services. Heywood Storrs. 1992; 115-1 16. 5. O‘Cathain A, Brazier JE. Milner PC. Fall M. Cost effectiveness of minor surgery in general practice: a prospective comparison with hospital practice. Br. 1. Gen. Pruc. 1992: 42: 13-1 7. 6. Slater D.Performance of skin biopsies by general practitioners. Br. Med. 1. 1991; 303: 1472.
Sir: We are grateful for the comments from Drs Manson, McMahon and Slater and gratified to see that their experience and views correspond with our own. We feel that the argument for routine histopathological examination of all surgically resected specimens is overwhelming from the ethical, clinical, medico-legal and academic points of view: we are less sanguine that these considerations will prevail over financial arguments. We agree with Dr Slater on the importance of the recent guidelines issued by The General Medical Services Committee and The Royal College of General Practitioners which was not to hand a t the time of going to press. It is gratifying to see that other histopathologists
Correspondence
hospital based nature of our surve:y,and most of the nonneoplastic and benign lesions identified were of little significance in their own right. Nevertheless, the lack of correlation between the clinical innpression and the true histopathological diagnosis suggests that, if such apparently trivial lesions are discarded important clinical conditions will be missed in a significant proportion of cases (in our study, between 1.7’ and 14.8%). Recent studies suggest that this proportion may be higher in the hands of general practitioners2 and further reinforces Cotton and Stephenson’s contention that routine histopathology of these and other similar lesions is necessary. As they suggest we, as histopathologists, should be informing our clinical colleagues of the value of clinicopathological correlation in training and audit at all possible opportunities. C.M.Manson R .F.T.McMahon Division of Histopathology, Department of Pathological Sciences, University of Manchester, Stopford Building, Oxford Road, Marichester M 1 3 9PT, UK
References 1 . Cotton DWK, Stephenson TJ. Histopathology for minor surgery. Histopathology 1992: 20: 455-456. 2. McWilliam LJ. Knox F, Wilkinson N, (logarah P. Performance of skin biopsies by general practitioners. Br. Med. 1. 1991: 303: 1 1 771179.
Sir: Presumably due to unfortunate timing, possibly the most important reference relating to minor surgery in general practice has not been included by Drs Cotton and Stephenson’. This comprises the recent guidelines issued by The General Medical Services Committee and The Royal College of General Practitioners’. Here, it is 6rmly stated that ‘all lesions removed during minor surgery should be sent for histological examination’. This is fortunate as, ironically, a different Sheffield University department has seriously queried the ‘expensive and time consuming option of sending all specimens for histopathological e ~ amin atio n ’~ This . view, however, does emphasise that we cannot forget the new ‘internal market’ and that general practitioners will be looking for the most cost-effective laboratory to report their specimens. Also, the guidelines and the general practitioner’s ‘red h a n d b ~ o kserve ’ ~ as timely reminders that, to date,
minor surgery histopathology has not been viewed on the same scale of importance as, for example, the national breast and cervical cytology screening programmes. The clinical importance of melanocytic lesions alone, makes this illogical in view of the rising incidence of melanoma and the necessity to correctly diagnose and treat early melanoma and its precursors. It is revealing that the only collaboration acknowledged in the guidelines is that with The Royal College of Surgeons. Similarly, perusal of the minor surgery list in the ‘red handbook’ suggests minimal histopathological contribution to its national formulation. It would appear imperative, as emphasized by Drs Cotton and Stephenson, that this situation is improved by histopathologists assuming a higher profile. D.Slater Department of Histopathology, Rot herham District Hospital, Moorgate Road, Oakwood, Rotherham S60 2UD, UK
References 1 . Cotton DWK, Stephenson TJ.Histopathology for minor surgery. Histopathology 1992: 20: 455-456. 2. Minor Surgery in General Practice. Guidelines by The General Medical Services Committee and The Royal College of General Practitioners. Department of Health. 1991: 1-5. 3. Brazier JE, Lowy A. Performance of skin biopsies by general practitioners. Br. Men. 1. 1991: 303: 1472. 4. Statement of fees and allowances. National Health Service General Medical Services. Heywood Storrs. 1992; 115-1 16. 5. O‘Cathain A, Brazier JE. Milner PC. Fall M. Cost effectiveness of minor surgery in general practice: a prospective comparison with hospital practice. Br. 1. Gen. Pruc. 1992: 42: 13-1 7. 6. Slater D.Performance of skin biopsies by general practitioners. Br. Med. 1. 1991; 303: 1472.
Sir: We are grateful for the comments from Drs Manson, McMahon and Slater and gratified to see that their experience and views correspond with our own. We feel that the argument for routine histopathological examination of all surgically resected specimens is overwhelming from the ethical, clinical, medico-legal and academic points of view: we are less sanguine that these considerations will prevail over financial arguments. We agree with Dr Slater on the importance of the recent guidelines issued by The General Medical Services Committee and The Royal College of General Practitioners which was not to hand a t the time of going to press. It is gratifying to see that other histopathologists
