Professor Carrie Newlands
About
Biography
Carrie was appointed as a Consultant Oral and Maxillofacial Surgeon (OMFS) in Guildford in 2003. She specialises in skin cancer management and is a co- author of UK Head and Neck, and British Association of Dermatology Guidelines on Basal Cell and Cutaneous Squamous Cell Carcinomas (cSCC).
Carrie is the former Chair of the OMFS FRCS examination Board, and co-led the eFace project, the eLearning for Health site for OMFS.
She works with the Royal College of Surgeons of England Invited review mechanism, which provides expert objective independant advice to healthcare organisations, in order to uphold standards of service delivery and the safe care of patients.
Her research interests include marginal control in skin cancers, and she is a member of the National Cancer Research Institute Skin Cancer group, and the SCC-After team who have been awarded an NIHR grant of £2.8M to carry out an RCT into the role of radiotherapy in high risk cSCC.
Carrie is currently co-leading The Working Party on Sexual Misconduct in Surgery (WPSMS), a group from the Women in Surgery Forum at the Royal College of Surgeons of England, to investigate sexual misconduct in the surgical workforce. WPSMS is committed to bringing about cultural change in surgery.
Publications
Non-melanoma skin cancer is the most common type of malignancy in the Caucasian population and is four times more common than any other cancer in the UK. One in four men and one in six women will develop a non-melanoma skin cancer in their lifetime. Mortality from nonmelanoma skin cancer is rare, but tends to be from local or regional disease. Distant metastasis is rare with the exception of Merkel cell carcinoma. The majority of non-melanoma skin cancers can be cured by adequate initial surgical management. High-risk and complex non-melanoma skin cancer may be challenging to manage, and must be carried out through a skin cancer multidisciplinary team (MDT). The majority of non-melanoma skin cancers occur in the skin of the head and neck. However, their clinical behaviours do not mirror that of head and neck mucosal malignancies. In order to optimise management and outcomes, all nonmelanoma skin cancers (with the exception of specifically defined low-risk basal cell carcinoma (BCC)) should be managed by core members of a skin cancer MDT. This chapter will describe the recommendations for the investigation and management of non-melanoma skin cancer, drawing on guidelines produced by the British Association of Dermatologists. These are recommended reading, as they are accepted as the national guidelines for the management of non-melanoma skin cancer and are mandated by the National Institute for Health and Care Excellence (NICE).
Background Pleomorphic Dermal Sarcoma (PDS) is increasing in incidence and evidence-based guidelines as to optimal management are lacking. It is unclear from guidance which cancer MDTs should be involved in the care of patients with PDS and there is anecdotally widespread variation in patient pathways and management. Objective To determine current pathways and opinions regarding management of PDS amongst members of relevant UK MDTs. Methods A survey was devised, piloted, and circulated to MDT members, via national organisations. Responses were analysed using online SurveyMonkey tools. Results 105 consultant members of a relevant MDT responded, including 19 skin and 2 sarcoma MDT Chairs. There was widespread variation in referral pathways, with 25.7% of participants reporting no sarcoma MDT involvement in a hypothetical case of a patient with a 2.1 cm primary PDS of the scalp, with no clinically apparent regional or distant metastases (N0M0). Opinions on the correct peripheral and deep surgical excision margins (PM/DM) varied, with the majority choosing a 10 mm PM (53.3%). Taking periosteum as the deep margin was preferred by 50.5%. Histological clearance margins of at least 5 mm at the PM and at least 1 mm at the DM were preferred by 33.3% of participants and deemed to be acceptable as definitive treatment. Imaging at diagnosis and for surveillance showed wide variation, with 24.8% not offering any imaging at diagnosis, in the above case. Conclusions PDS pathways and clinical management have been shown to vary widely amongst UK MDT members. A modified Delphi study is proposed to develop consensus-based guidance.
A year after publication of the Breaking the Silence report, the authors share the progress made and discuss what still needs to be done by us all.
Facial and head and neck skin lesions are usually obvious to patients and others, and advice is often sought as to their nature, with cosmetic removal of benign lesions regularly requested. Premalignant and malignant skin lesions are increasing in incidence, and this is related to sunshine exposure, an ageing Caucasian population, along with increasing numbers of patients who are immunosuppressed. Important surgical anatomical considerations in skin surgery relate to appropriate curative resection margins, specifically where the deep margin may involve or be close to important underlying structures. Suspected melanoma should undergo narrow excision biopsy where direct closure is possible. Closure can be by purse string, and any ellipse should be short, to preserve proximal lymphatic channels. Consider closure of the primary defect without the darts of an ellipse in thick skin. Closure of skin should be in layers with deep resorbable sutures to close any dead space and oppose the deep dermis.
AN INDEPENDENT REPORT ON SEXUAL MISCONDUCTBY COLLEAGUES IN THE SURGICAL WORKFORCE