Surgery remains the most effective option for treating most patients with nonmelanoma skin cancer, according to new clinical guidelines from the American Academy of Dermatology (AAD).
Excision, Mohs surgery, and curretage/electrodessication all have a role in the management of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) of the skin. Cryotherapy, radiation, and topical therapy are appropriate for selected patients.
The authors of separate guidelines for SCC and BCC did not recommend laser therapy or electronic brachytherapy, citing a lack of evidence to make informed decisions about the techniques.
“These two guidelines will help doctors provide the best possible care for patients with basal cell carcinoma and squamous cell carcinoma,” AAD working group co-chair Christopher K. Bichakjian, MD, of Michigan Medicine in Ann Arbor, said in a statement. “If they are left untreated, some nonmelanoma skin cancers may grow and spread, potentially leading to disfigurement and even death. When detected early, however, these skin cancers are highly treatable.”
The guidelines cover follow-up care for patients with SCC and BCC, recommending clinician-performed skin exams at least once at year after treatment. The panel also recommends precautions that every individual should take to prevent skin cancer, regardless of whether a person has a history of skin cancer. These include limiting sun exposure; wearing protective clothing; and using a broad-spectrum, water-resistant sunscreen with an SPF rating of at least 30. Everyone should perform a skin self-exam regularly and inform a clinician about any suspicious skin areas, including spots or lesions that change color, itch regularly, or bleed.
Both guidelines address a number of other issues related to the diagnosis and management of nonmelanoma skin cancer, including biopsy techniques, pathologic assessment, lesion staging, and management of new primary lesions, recurrent lesions, and advanced disease.
Nonmelanoma skin cancer is the most common type of cancer, resulting in more than 3 million new diagnoses each year in America. From 1976-1984 to 2000-2010, the incidence of BCC increased by 145% and the incidence of SCC by 263%, according to the AAD.