List of clinical questions

From Clinical Guidelines Wiki



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 
  • desmoplasiagrowth pattern characterised by sclerotic and extensive fibrous stroma 
  • 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.