Abstract
Background Skin cancer incidence is rising in the United Kingdom, increasing pressure on secondary care dermatology and surgical services. Community-based management delivered in local clinic settings outside hospital environments has been proposed to enhance access and efficiency for selected non-melanoma skin cancers. Evidence regarding the safety of community-based surgery for head and neck lesions, which carry a higher functional and cosmetic risk, is limited. This study evaluates outcomes from a specialist-led community head and neck skin cancer surgery service in the West Midlands, UK. Methods A single-centre retrospective observational study included all patients undergoing community-based head and neck surgery for suspected skin cancer. Excisions were performed by two head and neck surgeons between January and December 2023. Demographics, lesion histology, anatomical location, margin status, and postoperative outcomes were recorded. Narrow margins were histologically defined as<0.5 cm for all skin cancers. Primary outcomes were completeness of excision, margin involvement, and procedural complications. Postoperative infection was assessed in a randomly selected subset of 30 patients using simple random sampling. Descriptive statistics were used to summarise findings. Results A total of 101 patients underwent skin cancer surgery (59.4% male, 40.6% female; median age 75 years, interquartile range 19). Lesions included basal cell carcinoma (BCC) (38.6%, n = 39), squamous cell carcinoma (SCC) (13.9%, n = 14), melanoma in situ (5.0%, n = 5), melanoma (4.0%, n = 4), pre-cancerous lesions including Bowen's disease and actinic keratoses (5.9%, n = 6), basosquamous carcinoma (2.0%, n = 2), and benign lesions (30.7%, n = 31). Among malignant and pre-cancerous lesions (n = 70), complete excision was achieved in 98.6% (n = 69). One patient with basosquamous carcinoma had an involved margin (1.4%). Ten percent (n = 7) had narrow margins (<0.5 cm). No procedural complications were reported. Among 30 patients randomly selected for postoperative infection assessment, 77% (n = 23) were confirmed negative, and data were unavailable for 23% (n = 7). Conclusions Community-based specialist head and neck skin cancer surgery is safe and effective. When performed by appropriately trained professionals under Local Skin Multidisciplinary Team oversight, it achieves high rates of complete excision with minimal complications. Implementing specialist-led community clinics can improve patient access, reduce pressures on secondary care, and provide a scalable model for delivering high-quality skin cancer care closer to patients.