The Management and Treatment of Skin Cancer – Are We Doing it Right?
International Research Journal of Oncology,
Objective: This study aims to identify whether the University Hospital of Lewisham is managing patients according to the published guidelines and to create local guidelines for the identification and management of squamous cell carcinomas.
Design: This was a retrospective cross-sectional standards audit of patients diagnosed with squamous cell carcinoma at the University Hospital of Lewisham. A total of twenty patients were chosen at random for this study (out of a total of 79) by the specialist registrar dermatologist using a random number generator. Patients were divided into low-risk, high-risk and not recorded risks of squamous cell carcinoma. The number of follow-ups and the duration of follow-ups per patient was recorded.
Main Outcomes and Measures: To determine whether high-risk and low-risk squamous cell carcinomas are being managed in line with up to date guidelines. This is measured by the number of follow-ups, the duration in months of follow up and the time between each follow-up appointment and appropriate definitive treatment.
Results: This study had a mean age of 75 at diagnosis of squamous cell carcinoma (range 55-92); 12 of these patients were male and 8 of these patients were female. When comparing high-risk and low-risk squamous cell carcinoma patients using an unpaired t-test there was no statistical significance (p=>0.05) in the length of follow up, the frequency of follow-ups or the time between each follow-up appointment. Only 60% of patients followed up were provided education on self-examination. 100% of patients received appropriate definitive treatment.
Conclusions and Relevance: Management of patients diagnosed with squamous cell carcinomas at the University Hospital of Lewisham could be improved, especially in patients with low-risk squamous cell carcinomas. By following the suggested guidelines, the trust could reduce follow up appointments and the duration of follow up for low-risk squamous cell carcinoma patients attending the dermatology clinic.
- Squamous cell carcinoma
How to Cite
[Accessed on: 5 June 2019]
Rigel DS. Cutaneous ultraviolet exposure and its relationship to the development of skin cancer. J Am Acad Dermatol. 2008;58 (5 Suppl 2):S129-32.
DOI: 10.1016/j.jaad.2007.04.034. [PubMed: 18410798]
Brash DE, Rudolph JA, Simon JA, Lin A, McKenna GJ, Baden HP, Ponten J. A role for sunlight in skin cancer: UV-induced p53 mutations in squamous cell carcinoma. Proceedings of the National Academy of Sciences. 1991;88(22): 10124-10128.
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Archives of Dermatology. 1988;124(6): 869-871.
Beral V, Evans S, Shaw H, Milton G. Cutaneous factors related to the risk of malignant melanoma. British Journal of Dermatology. 1983;109(2):165-172.
Leblanc KJ, Hughes MP, Sheehan DJ. The role of sirolimus in the prevention of cutaneous squamous cell carcinoma in organ transplant recipients. Dermatol Surg. 2011;37(6):744-9.
DOI: 10.1111/j.1524-4725.2011.01973..x [PubMed: 21605234]
Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003;348(17):1681-91.
DOI: 10.1056/NEJMra022137 [PubMed: 12711744]
American Joint Committee on Cancer (AJCC). Cancer staging manual 8th edition; 2017.
Keohane S, Proby C, Newlands C, et al. The new 8th edition of TNM staging and its implications for skin cancer: A review by the British Association of dermatologists and the royal college of pathologists, UK. Br J Dermatol. 2018;179(4): 824-828.
Motley R, Preston P, Lawrence C. Multi-professional guidelines for the management of the patient with primary Cutaneous squamous cell Carcinoma. British Association of Dermatologists, London; 2009.
[Accessed on: 5 June 2019]
Leigh I. Progress in skin cancer: The UK experience. Br J Dermatol. 2014;171(3): 443-445.
Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. Journal of the American Academy of Dermatology. 2005; 53(2):253-260.
Pugliano‐Mauro M, Goldman G. Mohs surgery is effective for high‐risk cutaneous squamous cell carcinoma. Dermatologic Surgery. 2010;36(10):1544-1553.
Eedy D. Dermatology: A speciality in crisis. Clinical Medicine (London). 2015;15(6): 509-510.
Abstract View: 1761 times
PDF Download: 739 times