When to suspect a non-melanoma skin cancerBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m692 (Published 11 March 2020) Cite this as: BMJ 2020;368:m692
- H Smith, clinical fellow in dermatology,
- A Wernham, post-CCT fellow in Mohs micrographic surgery,
- A Patel, consultant dermatologist
- Department of Dermatology, Nottingham NHS Treatment Centre, Nottingham NG7 2FT, UK
- Correspondence to: H Smith
What you need to know
Non-melanoma skin cancer (NMSC) is more commonly diagnosed than all other malignancies combined
Consider risk factors for NMSC in all patients presenting with non-melanocytic skin lesions
A typical cutaneous squamous cell carcinoma may be a growing, tender, firm, skin-coloured nodule, sometimes with adherent surface scale, crust, or central ulceration
Assessing non-melanocytic skin lesions is a routine part of general practice. The key concern for patient and doctor is often whether the lesion may be a basal cell carcinoma or squamous cell carcinoma, collectively termed non-melanoma skin cancer (NMSC). This article aims to help primary care clinicians, who may not routinely have access to dermoscopy and biopsy, to identify possible NMSC lesions, which require further specialist assessment or monitoring.
How this article was made
We searched for relevant journal articles in the British Journal of Dermatology, BMJ, and British Association of Dermatology guidelines. A secondary literature search was conducted using Google Scholar with the key words “basal cell carcinoma,” “squamous cell carcinoma,” “non-melanoma skin cancer” associated with “risk factors,” “treatment,” “management,” “follow-up.”
Why is non-melanoma skin cancer on the increase?
Non-melanoma skin cancer is more commonly diagnosed than all other malignancies combined,1 and the incidence of skin cancer is rising, with rates of NMSC predicted to reach almost 400 000 per year in the UK by 2025.2 This is thought to be due to a combination of people living longer, increased exposure to ultraviolet (UV) light, and improved data collection and diagnostic tools.34 Risk factors are summarised in table 1, with the key environmental risk being UV exposure from tan-seeking behaviour and outdoor activities without adequate sun protection.12 Both basal cell carcinomas and cutaneous squamous cell carcinomas are more common with increasing age, with incidence of cutaneous squamous cell carcinomas peaking at 66 years of age.
Assessment of a non-melanocytic skin lesion
Box 1 summarises the procedure …