Skin cancer excision performance in Scottish primary and secondary care

I agree with the authors view that a secondary care specialist, supported by a multidisciplinary team within the hospital, will excise skin cancers with a greater degree of skill than the average GP. This seems obvious. What is much less clear, however, is whether this incremental technical quality, achieved at considerable cost, is truly clinically meaningful. This is the key issue to be addressed if the debate reinvigorated by this article is ever to move forward.