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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