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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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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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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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