Dr Marcus Platts-Mills, Dermatology and Skin Cancer Surgery specialist, talks with Dr Diana North, Goodfellow GP Advisorabout the management of non-melanoma skin cancer in primary care, including:
how to determine stage of basal cell carcinoma and squamous cell carcinoma
shave or punch biopsy or straight to excision
what topical treatments are available in General Practice
1. Non-melanoma skin cancers can take many forms. Differentiating between superficial squamous cell carcinomas and basal cell carcinomas can sometimes be difficult.
How do you go about diagnosing non-melanoma skin cancers in practice? Are you confident with dermoscopy? Does someone else in your practice have special expertise in diagnosing skin lesions?
Do you routinely biopsy these lesions? What issues and barriers are there around biopsying skin lesions? How might these be resolved?
2. There are now a number of options for treating superficial non-melanoma cancers.
Do you feel confident in the use of 5-fluorouracil and imiquimod? What issues do you have/have you experienced with these treatments?
Surgery remains the first line management for BCC and SCC. Discuss your approach with the group. Is this realistic? Do you offer topical treatments as a first line for any one with superficial lesions or just those who decline surgery?
At what point would you refer to a specialist or GP with a Special Interest (GPSI) for biopsy or excision? Does practice vary between the group? If it does, why might this be?
3. Actinic keratoses can be treated with cryotherapy. Where there is actinic field damage 5-fluorouracil may be more appropriate.
In your practice do you perform cryotherapy yourself, or do you delegate this to the nursing staff? Are there any potential issues with this approach? How many repeats of treatment for the same lesion do you allow before considering other options?
What would the next option be for an actinic keratosis not resolving with cryotherapy?
Have you ever used 5-fluorouracil for actinic field damage? What was this experience like (for the patient and for yourself)?
