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Feature Article

Nonmelanoma skin cancer: update on management

Robert Rosen

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Abstract

Nonmelanoma skin cancer is a common problem in Australia, affecting two-thirds of our population at some stage in their lives. The availability of new nonsurgical therapies has expanded the management options for affected patients.

Key Points

  • In Australia, nonmelanoma skin cancer occurs three times more frequently than all other cancers combined. Exposure to sunlight is the greatest single environmental cause.
  • Adequate lighting and magnification are needed to identify subtle lesions.
  • Depending on their location and subtype, BCCs and SCCs can cause considerable patient suffering. The tumours can be far more extensive than is visible clinically.
  • Imiquimod and photodynamic therapy are newer effective treatments for superficial and thin nodular BCCs with superior cosmetic results. However, they are not effective for other histological subtypes of BCC, which continue to grow and will require surgery.
  • Surgery requires appropriate facilities, equipment and assistance for safety and optimal outcomes. It has the lowest rates of recurrence; Moh’s serial excision has the least recurrence of all techniques.
  • Simple excision provides histological confirmation of a nonmelanoma skin cancer and of completeness of excision margins.

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