Introduction

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Introduction

Keratinocyte cancer (KC), formerly known as non-melanoma skin cancer,* comprises basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC).

Keratinocyte cancers cause approximately 560 deaths each year in Australia and are the reason for an estimated 939,000 treatments, based on 2015 data.[1] Keratinocyte cancers accounted for 8% of all health spending on cancer (excluding cancer screening) in Australia in 2008–2009, and Medical Benefits Schedule reimbursements for KC diagnosis, treatment and pathology cost an estimated $703 million in 2015. Thus, these mostly non-fatal cancers represent a large public health problem with disproportionately high costs.

Purpose and scope

The aim of these guidelines is to provide clear guidance on the diagnosis and management of KCs in the Australian population, based on current scientific evidence, in order to reduce morbidity (and, potentially, mortality) from these cancers.

These guidelines update the 2008 edition by reviewing literature published in the interim and incorporating new data. They provide up-to-date evidence-based recommendations, relevant to Australians and the Australian health care system, on skin cancer prevention and early detection, including the prevention and treatment of KCs in people at increased risk of the disease. The 2019 edition includes new information on advances in therapy, especially in the Metastatic disease and systemic therapies section. Sections on Organ transplantation and conditions associated with immunosuppression, Radiotherapy and Surgical treatment have been significantly revised. Guidance on managing KCs in patients who have undergone organ transplantation has been added throughout the guidelines, to aid clinicians who are increasingly involved in the care of these patients. A new section on Early detection has also been added.

Intended users

These guidelines are intended for use by health professionals, including those advising the general population about risk and prevention of KCs, those advising patients who are at increased risk of KCs (e.g. due to immunosuppression or a previous history of KC) about the need for and timing of future skin checks and follow-up, and all those involved in making the diagnosis or treating patients with KC.

They may also be of interest to policy makers and to educators providing training in medicine or other health sciences.

These guidelines are not intended as health information for the general public.

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Target populations

These guidelines cover the complete range of Australian adult populations and are an appropriate reference for health professionals treating adults of any age group.

It includes guidance on the asymptomatic general public, people at increased risk of KC, patients with KCs and related tumours of any stage, and patients who have received treatment for KC.

In implementing the recommendations, clinicians should consider the specific needs of patients with KC from culturally diverse groups, including younger people, Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse communities.

For each systematic review, the search strategies specifically included terms designed to identify data relevant to Aboriginal and Torres Strait Islander peoples. However, the literature searches did not identify any studies specifically relevant to Aboriginal and Torres Strait Islander populations that met the inclusion criteria.

Aboriginal and Torres Strait Islander peoples and people with darker skin are also at risk of developing KCs (albeit to a much lesser extent than those with lighter skin types), and it is important to deliver optimal care for all patients. The Optimal care pathway for Aboriginal and Torres Strait Islander people with canceris a useful reference resource for clinicians.

Healthcare settings in which the guideline will be applied

These guidelines apply to the range of public and private healthcare settings in which services are provided for the target populations. These include:

  • general practice
  • skin cancer clinics
  • hospitals
  • specialist clinics
  • imaging services
  • pathology services
  • allied healthcare services.

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Funding

The Australian Government Department of Health commissioned and funded Cancer Council Australia to undertake the current revision and update of these guidelines.

NHMRC approved recommendation types and definitions

These guidelines include evidence-based recommendations, consensus-based recommendations and practice points as defined by National Health and Medical Research Council (NHMRC) level and grades for recommendations for guidelines developers[2] (see NHMRC approved recommendation types and definitions in the Summary of recommendations section).

Methodology

The methodology adopted for this guideline revision is described in the Guideline development process and the Technical Report, which lists the clinical questions and includes detailed technical documentation.

It should be noted that throughout this guideline, unless otherwise stated, tumour stage is according to the American Joint Committee on Cancer (AJCC) cancer staging manual 8th edition[3] and Union for International Cancer Control (UICC) TNM classification of malignant tumours 8th edition.[4]

See: Appendix A TNM Staging.

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Scheduled review of these guidelines

It is inevitable that parts of this guideline will become out of date as further literature is published. Newly published evidence relevant to each systematic review question will be monitored. If strong evidence supporting a change in the guideline is published, the working party will consider if an update is required for a specific section. We recommend that the guideline should be reviewed and updated every 5 years.


Acknowledgement

The update of the guidelines was overseen by a multidisciplinary working party with input by subcommittees. We thank the members of the working party, subcommittees, systematic reviewers and all others who contributed to the development of these guidelines.

Medical writing and editing services were provided by Jenni Harman, Meducation Australia.

*The term ‘non-melanoma skin cancer' (NMSC) still appears in national data sets and reports.

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References

  1. Australian Institute of Health and Welfare (AIHW). Reports and data: Health conditions, disability & deaths (Cancer). [homepage on the internet] Australian Government; 2019 [cited 2019 Aug 16; updated 2019 Jan 9]. Available from: https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/cancer/overview.
  2. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Canberra; 2009 Available from: www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008-09.pdf.
  3. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, et al. (Eds.). AJCC Cancer Staging Manual (8th edition). Springer International Publishing: American Joint Commission on Cancer; 2017 [cited 2016 Dec 28].
  4. Brierley JD, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 8th Edition. Wiley-Blackwell; 2017.

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