Accountability

Dr Paul Alsop believes that accountability in skin cancer care requires transparency around outcomes, not just clinical intent.
To support this, histopathology results from skin cancer diagnosis and surgery are periodically reviewed and summarised as part of an outcomes audit.

The information below presents a 12-month audit of independently reported histopathology results across his 4 clinics. In contrast to registry-based audits that rely on clinician self-reporting, this review is generated directly from pathology data, reducing reporting bias and providing an objective measure of outcomes.

Source: Pathlab

For Patients

Why outcomes are reviewed

Whenever Dr Alsop removes or biopsies a skin lesion, it is sent to an independent laboratory for analysis. Reviewing these results helps ensure that care remains:

  • Focused on detecting skin cancer early

  • Avoidant of unnecessary procedures

  • Safe and appropriate when surgery is required

This process is known as a clinical audit and is a routine part of good medical practice.

What the audit showed (12 months)

  • 462 skin lesions were reviewed

  • 184 were skin cancers

  • 278 were benign or pre-cancerous

For every skin cancer identified, around one to two harmless lesions were removed.

By comparison, published audit data show that:

  • GPs (general practitioners) without additional skin cancer training typically remove around 3 to 6 harmless lesions for every skin cancer found.

  • Primary Care Skin Cancer Doctors (GPwSIs), who have additional training and experience, usually remove around 1½ to 2½ harmless lesions for every skin cancer found.

  • Dermatologists, who see highly selected referrals, often remove around 1 or fewer harmless lesions for each skin cancer found.

Dr Paul Alsop’s results fall squarely within the range expected for Primary Care Skin Cancer Doctors (GPwSIs) and overlap with specialist practice, while still identifying melanoma and higher-risk skin cancers when present.

Why this matters

Removing too many benign lesions can lead to unnecessary procedures and scarring.
Missing skin cancer is far more serious.

These results indicate a careful balance, being selective, while still detecting melanoma and higher-risk skin cancers when they are present.

Safety and cancer clearance

  • More than 96% of skin cancers were completely removed on the first procedure

  • All melanomas treated during this period were fully removed, with no cancer remaining on follow-up surgery

These outcomes are consistent with safe, high-quality skin cancer care.

Transparency

No audit is perfect, and not every skin lesion requires biopsy.
However, regularly reviewing outcomes and sharing them is one way Dr Alsop remains accountable to patients.

For Clinicians

Histopathology Outcomes Audit (12-month review)

Audit method

This is a 12-month retrospective audit based on independently reported histopathology.
All lesions submitted to pathology were included (diagnostic biopsies and definitive excisions).

  • Unit of analysis: Lesion-level pathology

  • Data source: External histopathology reports

This differs from registry-based systems such as SCARD, which rely on clinician-reported data and stratify outcomes by clinical intent.

Case mix and volume

  • Total lesions analysed: 462

  • Malignant lesions: 184 (39.8%)

  • Benign / premalignant lesions: 278 (60.2%)

Malignancies included BCC, SCC, SCC in situ, melanoma, and melanoma in situ.

Diagnostic selectivity

Benign-to-Malignant Ratio (B:M)

  • Observed B:M (Dr Paul Alsop):1.5 : 1

This means 1.5 benign or premalignant lesions were removed for every malignant lesion diagnosed.

Comparator context

Published audit literature consistently shows:

  • GPs (general practitioners) typically remove 3–6 benign lesions for every malignancy

  • Primary Care Skin Cancer Doctors (GPwSIs) typically remove 1.5–2.5 benign lesions per malignancy

  • Dermatologists typically remove 0.8–1.5 benign lesions per malignancy, reflecting highly selected referral populations

Interpretation

A B:M of 1.5 : 1:

  • Is well below general practice ranges

  • Sits within GPwSI benchmarks

  • Overlaps with dermatology-level selectivity, while operating in a broader diagnostic scope

This supports diagnostic selectivity rather than diagnostic omission.

Surgical quality – margins

  • Incomplete excision (malignant lesions):3.8% (7 / 184)

  • Narrow but clear margins (≤1 mm):4.9% (9 / 184)

These outcomes fall within accepted GPwSI and specialist-adjacent audit ranges and are consistent with outcomes reported in SCARD-aligned datasets, particularly when accounting for infiltrative BCC and anatomically constrained sites.

Comparator context

Published audit literature consistently shows:

  • GPs: ~8–32% incomplete excision

  • GPwSIs: ~2–5%

  • Dermatologists / plastic surgeons: ~2–5%

This audit: 3.8% incomplete — within GPwSI and specialist ranges.

Basal Cell Carcinoma (BCC)

  • Low-risk BCC (nodular/superficial):~64%

  • High-risk BCC subtypes:~36%

High-risk BCC included infiltrative, morphoeic, micronodular, and mixed aggressive patterns.

This distribution reflects a clinically complex BCC workload, not selective excision of low-risk disease alone.

Squamous Cell Carcinoma (SCC)

  • Invasive SCCs: 107

  • High-risk SCCs:43.0%

High-risk features included depth ≥2 mm, higher Clark level, moderate differentiation, and perineural invasion where present.

Melanoma outcomes

  • Melanoma / melanoma in situ: 17

  • Residual melanoma after completion wide local excision:0%

All melanoma pathways resulted in complete histological clearance.

Overall interpretation

Taken together, this audit demonstrates:

  • High diagnostic selectivity (B:M 1.5 : 1)

  • Margin outcomes within accepted GPwSI / SCARD-aligned ranges

  • Management of a complex case mix, including high-risk BCC and SCC

  • Oncologically safe melanoma pathways

Overall performance aligns with Primary Care Skin Cancer Doctor (GPwSI) practice and overlaps with specialist benchmarks, while operating within a broad primary-care diagnostic scope rather than a cosmetic or low-value excision model.

Comparator data are included for contextual reference only and should not be interpreted as formal benchmarks, thresholds, or indicators of clinical performance.

References

  1. SCARD Systems.
    Report for the SCARD Research Pool.
    Reporting period: 1 Feb 2025 – 16 Feb 2026.
    (287 clinicians; 121,929 lesions)

  2. Murchie P, et al.
    Diagnostic accuracy of skin cancer excisions in primary care: a retrospective observational study.
    British Journal of General Practice. 2011;61:e563–e569.

  3. Goulding JMR, et al.
    The accuracy of skin cancer excision by general practitioners in primary care.
    British Journal of Dermatology. 2001;145:884–888.

  4. Reid CM, et al.
    Skin cancer management by general practitioners with advanced training.
    Medical Journal of Australia. 2010;193(6):328–332.

  5. Roozeboom MH, et al.
    Incomplete excision of basal cell carcinoma: a systematic review.
    British Journal of Dermatology. 2012;167:353–361.

  6. Bath-Hextall FJ, et al.
    Surgical excision versus other treatments for basal cell carcinoma.
    British Journal of Dermatology. 2007;156:848–857.

  7. Rowe DE, Carroll RJ, Day CL.
    Long-term recurrence rates in previously untreated basal cell carcinoma.
    Journal of the American Academy of Dermatology. 1989;21(5):756–764.

  8. Leffell DJ, et al.
    Surgical treatment of nonmelanoma skin cancer.
    New England Journal of Medicine. 2001;345:976–983.

  9. Hallock A, et al.
    Audit of skin lesion excision and diagnostic yield in primary care.
    British Journal of Dermatology.

  10. English DR, et al.
    Incidence of cutaneous melanoma and diagnostic accuracy in primary care.
    Medical Journal of Australia.

  11. Australian Skin Cancer Audit Research Database (SCARD).
    SCARD Research Pool Outcomes Report.

  12. Australian Skin Cancer Audit Research Database (SCARD).
    SCARD Methods and Definitions Document.

Longitudinal Comparison

This table summarises key outcome metrics from Dr Paul Alsop’s 2021 pathology audit compared with the current 12-month histopathology audit. Both audits are based on independently reported histopathology (externally generated), analysed at lesion level.

Domain 2021 data Current 12-month audit Interpretation
Data source Independent histopathology Independent histopathology Both externally derived; not clinician self-reporting
Reporting unit Sample / lesion level Lesion level Methodologically comparable
Clinical scope High-volume mixed diagnostic & surgical Mixed diagnostic & definitive Consistent practice scope
Surgical episodes 387 N/A (lesion-based) 2021 reflects high procedural volume
Lesions / samples analysed ~1,130 samples 462 lesions Both represent multi-lesion practice
Average lesions per episode ~2.9 N/A Indicates systematic multi-lesion assessment (2021)
BCC volume 176 Major malignant component Consistent prominence of BCC across audits
BCC subtype mix Aggressive subtypes present (subtyped) High-risk BCC ~36% of BCCs Ongoing management of aggressive BCC patterns
Invasive SCC 86 107 Sustained SCC workload
High-risk SCC Not explicitly quantified 43.0% Demonstrated risk recognition in current audit
Melanoma 21 invasive 17 (incl. MIS) Stable melanoma detection
Melanoma in situ (MIS) 6 Included in total melanoma/MIS Consistent early detection
Clinical → histological melanoma concordance 67.7% Not primary metric in this audit Strong pigmented lesion selectivity demonstrated in 2021
Pigmented lesion pick-up ~1 melanoma per 4–5 pigmented lesions excised Not isolated in current audit High melanoma detection efficiency in 2021
Malignancy yield High malignant workload (large absolute volumes) 39.8% malignant lesions Sustained malignant yield over time
Benign-to-malignant ratio (B:M) Not directly reported 1.5 : 1 Confirms global diagnostic selectivity in current practice
Incomplete excision (malignant) Not isolated 3.8% Acceptable surgical quality in current audit
Residual melanoma after completion WLE Not reported 0% Oncologically safe melanoma pathways in current audit