Should antibiotics be prescribed to patients during skin cancer surgery to prevent infection?

A new study aims to show whether antibiotics should be prescribed to patients at the time of skin cancer surgical removal to reduce the risk of wound infection.

Researchers in Wales aim to establish whether oral antibiotics are effective in preventing surgical site infection (SSI) in adults who have undergone surgical removal of an ulcerated skin cancer under local anaesthesia.

The EXCISE trial is a randomised controlled trial (RCT) funded by the National Institute for Health and Care Research (NIHR), with 380 adults who are undergoing surgical removal of ulcerated skin cancer able to take part from participating UK NHS hospitals. All patients entered into the trial will be assigned equally to receive either antibiotics or placebo.

Skin cancer is the most common type of cancer. Every year in the UK, over 200,000 people have their skin cancer removed surgically. Some people develop skin cancers that break through the skin surface causing a wound on the skin (called an ulcerated skin cancer) which are six times more likely to develop a wound infection after surgery. Doctors often prescribe antibiotics at the time of surgery to prevent wound infections, but we do not know whether antibiotics reduce the risk of getting an infection.

Adults in the EXCISE trial will be given a one-off dose of antibiotic or no antibiotic (placebo) to see how many in each group develop wound infections. Follow-up telephone calls with participants at regular intervals after surgery will take place to ask about their wound, signs of infection and any side effects. Participants will be seen in hospital if a wound infection is suspected and will receive additional treatment if required. Patients may also choose to take part in interviews about how long it took to return to normal activity and the impact on daily life at after surgery. At the end of the trial, when it is known how many developed a wound infection, the results will help researchers to decide whether antibiotics should be given to patients before skin surgery and whether this reduces the risk of wound infection.

The EXCISE trial is being run from the Centre for Trials Research (CTR) at Cardiff University and is led by Dr Rachel Abbott and Dr Emma Thomas-Jones. Dr Rachel Abbott is a consultant dermatologist at Cardiff and Vale University Health Board who specialises in skin cancer and skin surgery. Dr Emma Thomas-Jones is a principal Research Fellow and Deputy Director of the Infections, Inflammation and Immunity Division at the CTR, a UKCRC registered clinical trials unit.

“EXCISE is the first UK trial looking into whether antibiotic tablets are effective in reducing the risk of wound infection in people undergoing surgery for skin cancer. Our team, together with the wider patient and clinician community, have worked hard to develop this trial and we are now looking forward to providing robust evidence to inform future patient care. ” - Dr Rachel Abbott, Consultant Dermatologist.

“‘I am delighted to be co-leading this trial with Dr Rachel Abbott, which is a continuation of our work to establish the evidence for appropriate use of antibiotics for patients undergoing skin cancer surgery’. The trial will hopefully lead to standardising practice within the NHS and benefit patients. ” - Dr Emma Thomas-Jones, Principal research fellow at Cardiff CTR

Collaborating partners on the study include academics from the Swansea Centre for Health Economics, University of York, University of Oxford, Public Health Wales, Oxford University Hospitals NHS Foundation Trust, Walsall Healthcare NHS Trust, and NHS Tayside. The study team are also working closely with patient and public Involvement representatives. The study is funded by the NIHR and runs for three years, with results expected in 2028. The Centre for Trials Research at Cardiff University is funded by Welsh Government through Health and Care Research Wales.