List of clinical questions

This page lists the questions answered by systematic review and modelling. For full details about the reviews, including the inclusion and exclusion criteria, please see the Technical report.

Epidemiology (section lead: Adele Green & David Whiteman)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Prevention (section lead: Craig Sinclair)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Early detection (section lead: David Whiteman)

Background chapter based on general literature summary. This is a new section of the guideline. Practice points were included as guidance.

Clinical features (section lead: Morton Rawlin)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Pathology (section lead: Vicki Howard)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Prognosis (section lead: David Speakman)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Surgical treatment (section lead: Peter Callan)

Clinical question SX1: What factors need to be considered when determining if surgical treatment modalities are optimal over non-surgical modalities for the management and/or treatment of basal cell carcinoma or cutaneous squamous cell carcinoma?

Population	Risk factors	Outcomes
Patients with basal or squamous cell carcinoma	Tumour location  Tumour histology  Depth of invasion  Risk of surgery  Diffuse disease  Patient factors (family history, immunocompromised, comorbidities)	Local recurrence rates  Disease-free survival  Adverse events  Cure rate  Completeness of excision  Preservation of function

Clinical question SX2: What factors need to be considered when determining the optimal surgical technique for those with basal cell carcinoma?

Population	Risk factors	Outcomes
Patient with primary basal cell carcinoma	Patient with primary basal cell carcinoma  Experience of the operator  Type of basal cell carcinoma Histological features:  morphoeic  micronodular  infiltrating  Tumour size (surface area)  Tumour location  Lesion depth of invasion  Perineural invasion   Excision margin	Cure rate  Local recurrence rate  Completeness of excision  Preservation of function

Clinical question SX3: In patients undergoing surgical treatment for cutaneous squamous cell carcinoma, which surgery-related factors (margin width, depth of excision) or tumour-related factors (size, histological features, anatomical site) influence clinical outcomes (cure rate, local recurrence, regional lymph node involvement, metastasis)?

Population	Risk factors	Outcomes
Patients with primary squamous cell carcinoma	Surgical margin (2-10 mm)  Surgical margin (1 mm)  Tumour size (surface area)  Histological features:  well-differentiated  poorly differentiated  desmoplasia  spindle cell carcinoma  acantholytics squamous cell carcinoma adenosquamous tumours  Depth of excision  Anatomical site	Cure rate  Local recurrence rate  Positive regional lymph nodes  Distal metastasis

Clinical question SX4: What should be the protocol to manage incomplete resected basal cell carcinoma?

Population	Intervention	Comparator	Outcomes
Patients with incomplete resected basal cell carcinoma	Re-excision  Radiotherapy  Observation	An alternative management or treatment modality	Recurrence

Clinical question SX5: What should be the protocol to manage rapidly growing tumours?

Population	Intervention	Comparator	Outcomes
Basal or squamous cell carcinoma patients with perineural invasion	Surgery + definitive radiotherapy  Surgery + adjuvant radiotherapy  High dose radiotherapy  Surgery (Mohs Micrographic surgery)	An alternative treatment modality or no comparator	Recurrence rate   Cancer-specific mortality  Local regional spread  Distal metastases

Radiotherapy (section lead: Gerald Fogarty)

Clinical question RT1: When should radiotherapy be used alone, or in combination with surgical excision to treat those with keratinocyte cancers?

Population	Intervention	Comparator	Outcomes
Patients diagnosed with basal cell carcinoma or squamous cell carcinoma	Radiotherapy alone	Radiotherapy and surgical excision	Recurrence rates Local control Regional control Distant control Overall survival Relapse-free survival Disease-specific survival Cosmetic outcomes Functionality outcomes

Clinical question RT2: In which patients with basal cell carcinoma does a radiotherapy modality achieve equal or better outcomes than conventional surgery?

Population	Intervention	Comparator	Outcomes
Patient with basal cell carcinoma	Definitive radiotherapy	Alterative treatment no comparator  alternative radiotherapy  dose	5-year local control  recurrence rates  cosmetic and/or functional  aspects survival outcomes

Clinical question RT3: In which patients with cutaneous squamous cell carcinoma does a radiotherapy modality achieve equal or better outcomes than conventional surgery?

Population	Intervention	Comparator	Outcomes
Patients with squamous cell carcinoma	Definitive radiotherapy	Alterative treatment no comparator alternative radiotherapy dose	5-year local control recurrence rates cosmetic and/or functional aspects survival outcomes

Cryotherapy and electrodessication and diathermy (section lead: Peter Foley & Stephen Shumack)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Topical treatments and photodynamic therapy (section lead: Peter Foley & Stephen Shumack)

Clinical question OT1: What role does ingenol mebutate gel have in the treatment and management of basal cell carcinoma and/or cutaneous squamous cell carcinoma?

Population	Intervention	Comparator	Outcomes
Patients with primary basal cell carcinomas (BCC) or squamous cell carcinomas (SCC), including: - Superficial BCC (sBCC) - SCC in situ (SCCIS)	Ingenol mebutate (IM) gel topical treatment	Alternative concentration of IM gel, or alternative treatment regime	Adverse events (AEs) Recurrence rates Response rates

Organ transplantation and conditions associated with immunosuppression (section lead: Alvin Chong & Adele Green)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Metastatic disease and systematic therapies (section lead: Alex Guminski)

Clinical question MS1: What should be the protocol to manage or treat locoregionally advanced cutaneous squamous cell carcinoma?

Population	Intervention	Comparator	Outcomes
Patients with locally advanced squamous cell carcinoma, including recurrent disease, nodal involvement, a bulky or invasive primary, perineural invasion, or gross/microscopic positive margins.	One of the following: Cetuximab alone Cetuximab + chemotherapy Cetuximab + radiotherapy Cisplatin (or Pt) + radiotherapy Surgery + chemotherapy + radiotherapy Surgery + radiotherapy Surgery + adjuvant radiotherapy Systemic therapy + adjuvant radiotherapy	An alternative treatment, or no comparator.	Local regional control Distant control Progression-free survival Overall survival Mortality

Follow-up (section lead: Morton Rawlin)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

The role of primary care in the prevention and management of keratinocyte cancer (section lead: Paul Fishburn)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Economics of keratinocyte cancer (section lead: Louisa Gordon)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

Common concerns raised by patients (section lead: Helena Rosengren)

Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.

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