The incidence of skin cancer in dermatology

Background It is known that the incidence of skin cancer is rising rapidly worldwide, but no reliable figures on multiple nonmelanoma skin cancer (NMSC) are available. Aim To determine the actual incidence of skin cancer in dermatology practice and to estimate how this relates to the first primary tumours (registered at the Eindhoven Cancer Registry). Methods We examined 1001 randomly selected patient records at Catharina Hospital Eindhoven for mention of skin cancer. For each patient, skin cancers were recorded in a database, starting from 1 January 2004 until 1 March 2010. The time interval between tumours and any history of skin cancer were also recorded. Results Of this group, 876 patients were treated for skin cancer during the study period. We recorded a total of 2106 tumours with a mean of 2.4 skin cancers per patient. Nearly half (46%) of patients developed multiple tumours, and the second tumour developed within a median period of 5 months. Over a quarter (28%) of patients were known to have had skin cancer before 2004, the start of the study period. Conclusions The number of NMSCs in practice differs substantially from the number of first primary histologically confirmed NMSCs, as usually reported by the Eindhoven Cancer Registry. To obtain the optimum benefit from registration of NMSC, it is recommended to register all NMSCs, because only this complete number will give an insight into the incidence of the rising skin-cancer numbers. Because subsequent tumours occur frequently, NMSC should be regarded as a chronic disease, and innovations in disease management are required for cost-effective control. Click here for the corresponding questions to this CME article. © 2013 British Association of Dermatologists

Imiquimod 5% cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: a prospective randomized controlled study

Background Imiquimod 5% cream can reduce or clear superficial and small nodular basal cell carcinoma (BCC). It could be used as a pretreatment of Mohs micrographic surgery (MMS) to decrease defect size. Objectives To study if a pretreatment with imiquimod 5% cream decreases defect size after MMS. In addition, to study the effect on the number of Mohs stages and reconstruction time. Methods Seventy patients aged >18 years with a primary nodular BCC in the face were included. The imiquimod group used imiquimod 5% cream for 4 weeks, before MMS. The control group was treated with MMS only. Tumour and defect sizes were measured. We noted the number of Mohs stages, reconstruction time and side-effects. Results The median percentage increase in area from tumour size at baseline to the post-MMS defect for the imiquimod group was significantly less compared with the control group, 50% vs. 147% (P < 0.001). A tendency towards fewer Mohs stages in the imiquimod group was observed and the reconstruction time was significantly shorter in this group (P = 0.01). Conclusions Imiquimod 5% cream as pretreatment of MMS significantly reduced the tumour size in primary nodular BCC and reduced the surgical defect size. Further research is necessary to investigate cost-effectiveness