Melanoma and keratinocyte skin cancer detection

Overview

Skin cancer is Australia's national cancer burden: roughly two in three Australians will be treated for skin cancer during their lives, keratinocyte cancers (BCC and SCC) are among the most common malignancies diagnosed, and melanoma kills more young Australians than any other cancer.^[8] General practice performs the whole detection chain — risk assessment, examination, dermoscopy, biopsy decisions, referral and prevention counselling.

The detection task divides cleanly. Melanoma recognition rests on pattern change (ABCDE, ugly duckling) supported by dermoscopy, and on never sampling suspected melanoma partially. Keratinocyte cancer recognition rests on lesion behaviour and site: BCCs invade locally and rarely metastasise; SCCs metastasise at meaningful rates, especially on ears and lips. Both demand excisional certainty.^[3]

References8ShowHide

1. [1]Green AC et al. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol, 2011.PMID 21135266
2. [2]Vestergaard ME et al. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol, 2008.PMID 18616769
3. [3]Wheatley K et al. Surgical excision margins in primary cutaneous melanoma: A meta-analysis and Bayesian probability evaluation. Cancer Treat Rev, 2016.PMID 26563920
4. [4]Hayes AJ et al. Wide versus narrow excision margins for high-risk, primary cutaneous melanomas: long-term follow-up of survival in a randomised trial. Lancet Oncol, 2016.PMID 26790922
5. [5]Skulsky SL et al. Review of high-risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. Head Neck, 2017.PMID 27882625
6. [6]Stratigos A et al. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline. Eur J Cancer, 2015.PMID 26219687
7. [7]Daudén E Effectiveness and satisfaction with imiquimod for the treatment of superficial basal cell carcinoma in daily dermatological practice. J Eur Acad Dermatol Venereol, 2011.PMID 21348896
8. [8]Betti R et al. Factors of delay in the diagnosis of melanoma. Eur J Dermatol, 2003.PMID 12695136