4. Clinical features of keratinocyte cancer
The high prevalence of keratinocyte cancer (KC), previously known as non-melanoma skin cancer, in Australia makes it imperative that all clinicians are familiar with its various presentations. Early detection of these lesions is important in minimising their associated morbidity, costs of treatment and mortality.
Clinical examination that is conducted for other purposes, particularly in the general practice setting provides opportunities for opportunistic skin checks and early detection of KC.
In addition to the clinical features evident at the time of consultation, clinical history also provides important evidence on which to base a diagnosis. Keratinocyte cancers change over time, and this is generally evident over a period of months. Many are also symptomatic. These features vary between basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC), and related tumours.
Some lesions will be confidently diagnosed on clinical examination and history while others, particularly early lesions with subtle clinical features, will require biopsy. Biopsy techniques such as punch, shave, incisional and excisional biopsy can be appropriate in the assessment of selected KCs (see: Pathology).
Consideration should be given to the role of pre-treatment biopsy in confirming the presence of skin cancer, the type, its growth pattern, prognostic features and the most appropriate modality to maximise the chance of cure and minimise treatment-related morbidity.
General practitioners (GPs) should consider skin checks for all patients over the age of 40, particularly for the elderly. Patients with special risk factors (see: Epidemiology) should be considered for entry to a regular surveillance program with their GP or dermatologist.
A substantial proportion of KCs occur on the intermittently exposed parts of the trunk and limbs, and it is worthwhile to examine these areas in addition to the head and neck, hands and forearms. The examination should be conducted in a well-lit area and magnification may be useful. Atlases are available that illustrate the clinical features of KCs.
Topics covered in this section include:
- Mackie R. An illustrated guide to the aetiology, clinical features, pathology and management of benign and malignant cutaneous tumours. London: Martin Dunitz Ltd; 1989.