Is Early Detection of Basal Cell Carcinoma Worthwhile? Systematic Review Based on the WHO Criteria for Screening

Is Early Detection of Basal Cell Carcinoma Worthwhile?

Systematic Review Based on the WHO Criteria for Screening

British Journal of Dermatology (2016) 174, pp1258-1265

Presented By

Robertus Arian Datusanantyo

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I. Hoorens; K. Vossaert; K. Ongenae; L. Brochez

Background

• BCC: common in Europe

• Risk factor (?)

• Diagnosis delay

• WHO criteria for screening

Objective 1. Discuss whether current evidence support early

detection and treatment of BCC to reduce important morbidity and costs.

2. Address evidence insufficiency in critical areas

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WHO Criteria for Screening

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Methods

• Applicable studies of BCC: – Natural history

– Cost of treatment

– Treatment

– Cost-effectiveness

– Cost of illness

• Database: – PubMed

– Cochrane

– Medline

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Important health problem?

• Most common cancer of whites, increasing rate

• Multiple primary lesion

• Head & neck

– Visibility

– Anatomical complexity

– Direct connection to brain

• Burden for healthcare system

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Natural course of BCC is known

• Growth rate

– Slow

– Initial size, male, recurrent tumours

• Histology

– 66 subtypes

– Superficial, fibroepithelial, nodular, infiltrative

• Metastasis

– Extremely rare

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Detectable latent stage

• 0.5 mm / 10 weeks (face)

• 0.7 mm / 8.7 weeks (head – neck)

• 2.4 – 3.8 years to reach 10 mm

• Metastasis: rare

• Several years precede metastatic or giant stage

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Suitable screening method: accepted

• Naked-eye inspection

• Dermoscopy

– Improves diagnosis accuracy

– Reduce unnecessary referrals, excicions, biopsies

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Acceptable method of treatment

• Tumour size (>20mm vs <20mm)

• Primary/recurrent, histological subtype, tumour location

• Surgery: safety margins (3mm, 5mm)

• Mohs micrographic surgery: expensive

• Non-surgical: 5-fluorouracil, imiquimod, photodynamic therapy

• Destructive: cryosurgery, curretage, cautery, carbondioxide laser

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Provision for diagnosis & treatment

• Naked eye inspection

• Dermoscopy

• Treatment options

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Screening: cost effective

• BCC in face:

– More costly

– Higher risk of recurrence

• Size of lesions indirectly influence cost

• Cost per primary treatment modality increases with increasing lesional size

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Discussion

• Include BCC in skin cancer screening initiatives

• Size complexity, effectiveness, cost of surgery

• Appropriate selection of initial treatment; failure second treatment

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Conclusions

• BCC in the facial area fulfills the majority of the WHO criteria for screening.

• Early detection and adequate treatment can reduce treatment complexity and cost, and offer the best chance for control.

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Thank You!

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