Actinic keratoses need to be removed before they turn into SCCs. The prognostic significance of ulceration of cutaneous SCCs needs to be determined.

Two methods for the assessment of severity of actinic skin damage were evaluated in a population-based survey of 1216 subjects. After controlling for the effects of age, skin texture changes graded by cutaneous microtopography were found to be associated strongly with the presence of solar keratoses and a past history of non-melanotic skin cancer. Changes in skin condition graded by paraocular photography had a weaker relationship with the presence of keratoses and showed no association with non-melanotic skin cancer. These results, together with a higher level of agreement between observers in grading cutaneous microtopographs, support the use of cutaneous microtopography as an index of actinic skin damage in epidemiological research.

Background: The frequency with which squamous cell carcinoma (SCC) of the skin metastasizes is a matter of dispute. Studies from private practices have reported much lower rates than hospital-based surveys, and one school of thought is that SCCs which arise in sun-damaged skin have a low risk of metastasis. Methods: A prospective study of out-patients with histologically confirmed SCC was undertaken in southern Australia, a region with a very high incidence of skin cancer. Results: Between November 1988 and November 1989, 481 patients were entered into the study and 420 followed for at least 3 years. An SCC was the initial diagnosis for 73 patients, 3 were immunosuppressed and 2 had an SCC of the lip, leaving 68 immunocompetent patients with SCC of the skin. Metastatic SCC developed in 2 patients (5.8% adjusted for losses) within 3 years. The SCCs were small and arose in sun-damaged skin. Conclusion: Patients with SCC of the skin need a careful follow-up because of the risk of metastasis.

Objective: To determine the incidence of new skin cancer formation in people who have had skin cancer removed. Study Design: A prospective study of Melbourne out-patients with histologically confirmed non-melanoma skin cancer (NMSC). All patients with NMSC seen by one author (D.C.) between November 1988 and November 1989 were entered into the study and reviewed regularly. New skin cancers were removed and recorded. Results: Four hundred and eighty-one patients were entered and 420 followed for at least 3 years. New NMSC developed in 60% (adjusted for losses) by the end of 3 years. A multivariate analysis determined that the main risk factor for new NMSC formation was the number of previous skin cancers that a patient had. Those who had had multiple skin cancers (3 or more) were at significantly greater risk than those with less than 3. Age, sex and type of NMSC were not risk factors for new skin cancer formation. Conclusion: Patients with NMSC require long-term follow-up because of the risk of new skin cancer formation. Those with multiple NMSC need more careful follow-up, and possibly more frequent examinations, because they are at greater risk.

Patients who have had multiple skin cancers require careful follow-up because of the risk of developing recurrences.