Evaluation, Staging and Prognostication
The majority of non-melanoma skin cancers (NMSCs), particularly those encountered in primary care settings, will be identified and are easily amenable to local therapy. The most common types of NMSC are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and rarer tumours, including Merkel cell cancer (MCC) and sarcoma. Metastatic SCC is a rare entity (<5 % of cases); metastatic BCC even more so . However, it is important to identify high-risk patients because of the significant morbidity and mortality experienced by this subgroup of patients. Optimal management of these patients requires multidisciplinary input. Considerable research has been conducted into early identification of such high-risk patients. The initial approach involves a thorough clinical assessment, including detailed history and evaluation of any relevant systemic disease, risk factors and comorbidities, followed by histological analysis. Advanced lesions will require more detailed investigations, including cross-sectional imaging in the form of computed tomography (CT) and or magnetic resonance imaging (MRI). The investigation should not only focus on the primary lesion but also on any potential regional and distant metastatic disease. One approach to the initial assessment of NMSC is shown in Fig. 3.1.
KeywordsEpidermal Growth Factor Receptor Squamous Cell Carcinoma Basal Cell Carcinoma Perineural Invasion Actinic Keratosis
- 1.Snow SN, Mohs FE. Metastatic basal cell carcinoma. In: Roenigk RK, Roenigk Jr HH, editors. Surgical dermatology: advances in current practice. London: Martin Dunitz; 1993. p. 109–23.Google Scholar
- 2.Tufaro AP, Prasad NB, Fischer AC et al. The clinicopathologic and molecular aspects of non-melanoma skin cancer. In: Khopkar U, editor. Skin biopsy: perspectives. InTech; 2011. pp. 197–208. Available at: http://www.intechopen.com/books/skin-biopsy-perspectives/the-clinicopathologic-and-molecular-aspects-of-non-melanoma-skin-cancer.
- 8.LeBoit PE, Burg G, Weedon D, Sarasain A (eds.). World Health Organization Classification of Tumours. Pathology and Genetics of Skin Tumours. Lyon: IARC Press; 2006.Google Scholar
- 13.Edge S, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
- 23.Motley R, Kersey P, Lawrence C, British Association of Dermatologists, British Association of Plastic Surgeons, Royal College of Radiologists, Faculty of Clinical Oncology. Multiprofessional guidelines for the management of the patient with primary cutaneous squamous cell carcinoma. Br J Dermatol. 2002;146:18–25.CrossRefPubMedGoogle Scholar