Background Skin cancers from a large proportion of UK Dermatologists' work are inaccurately recorded. Increasingly we are expected to audit our work for quality and timeliness of diagnosis and treatment.
Methods Since the beginning of 2000 we have incorporated the use of a database in our day-to-day work to record clinical and management details of all nonmelanoma skin cancers treated in the Dermatology outpatients clinic. Malignant melanoma detected in our Health Authority area have been recorded since 1987. The same database system can be used as an epidemiological tool or to follow the progress of individual patients through follow-up data. Whenever a person is alive as defined through a confirmed R D & E contact this fact is automatically entered onto the database, allowing our mortality tables to be reasonably accurate. We are in control of the data entry and are able to check for accuracy against histological records on a regular quarterly basis, demonstrating unequivocally how inaccurate are Regional Cancer Registries. We monitor waiting times of patients, numbers and types of procedures and activity of different doctors.
Results Since 1987 malignant melanoma has increased from 20 per 100 000–30 per 100 000 with a marked change in gender incidence. The major increase has been in early and in situ melanoma, except in men where we show a disturbing increase in invasive lesions. In Exeter half the nonmelanoma skin cancers come to us with the site and age range as expected. As time goes on we should get a good idea of our recurrence rate. Thus far, this is not a large proportion of our work, but we have no idea how much goes to the plastic surgeons. In addition, there are fairly small numbers needing flaps, grafts, second procedures or referral on to surgeons.
Results The case for increased resourcing can be easily supported by reports generated in a timely manner by such a system.