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)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
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:
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 |
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:
carcinoma
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)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
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:
|
An alternative treatment,
or no comparator. |
Local regional control
Distant control Progression-free survival Overall survival Mortality |
Follow-up (section lead: Morton Rawlin)[edit source]
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)[edit source]
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)[edit source]
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)[edit source]
Background chapter based on general literature summary. The 2008 content was reviewed and updated where required. Practice points were included as guidance.