Identification of Incidental Skin Cancers Among Adults Referred to Dermatologists for Suspicious Skin Lesions

Omara, Sharif; Wen, David; Ng, Benjamin Kwan Lok; Anand, Rakesh; Matin, Rubeta; Taghipour, Kathy; Esdaile, Ben

doi:10.1001/jamanetworkopen.2020.30107

Cited by 13 publications

(11 citation statements)

References 41 publications

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“…Besides this, GPs may have been more reserved in referring patients with a suspected BCC compared to patients with a suspected cSCC. Moreover, compared to cSCCs, BCCs are more often detected incidentally during the examination of a patient referred to a dermatologist for a different reason 16–18 . The overall decline in dermatology consultations has likely reduced the number of these incidental finds, thereby contributing to a stronger decline in BCC diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, compared to cSCCs, BCCs are more often detected incidentally during the examination of a patient referred to a dermatologist for a different reason. [16][17][18] The overall decline in dermatology consultations has likely reduced the number of these incidental finds, thereby contributing to a stronger decline in BCC diagnoses. This is supported by the steep decline in BCC diagnoses that was observed as soon as the number of dermatology consultations started to decline.…”

Section: Discussionmentioning

confidence: 99%

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The impact of the COVID‐19 pandemic on keratinocyte carcinoma in the Netherlands: Trends in diagnoses and magnitude of diagnostic delays

Slotman

Schreuder

Nijsten

et al. 2022

Acad Dermatol Venereol

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Background The COVID-19 pandemic impacted Dutch society and the healthcare system. Focus switched to care for COVID-19 patients, thereby altering care for non-COVID patients. Non-urgent medical visits were cancelled or postponed and patients were reluctant to visit healthcare services.Objectives This study aimed to investigate the impact of the COVID-19 pandemic on trends in diagnoses of keratinocyte carcinoma (cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC)) and to assess the magnitude of diagnostic delays. MethodsThe number of cSCC and BCC diagnoses in each month of 2020 was compared to the expected number of diagnoses for these months, using data from the Netherlands Cancer Registry. Expected diagnoses for 2020 were used as a reference to take the yearly increase in keratinocyte carcinoma incidence into account and were calculated by extrapolating the trends observed in 2017-2019. Comparisons were further stratified by age, sex and region. Estimates of diagnostic delays were calculated and corrected for the influence of excess mortality due to the pandemic on keratinocyte carcinoma incidence. ResultsThe number of cSCC and BCC diagnoses substantially decreased when compared to the number of diagnoses expected from March to May 2020 (cSCC À29%, BCC À50%). These decreases were observed across all age groups, both sexes, and all regions. From June to September the number of cSCC and BCC diagnoses was higher than expected, after which it slightly dropped below expected in October to December. In total, 2020 keratinocyte carcinoma diagnoses continued to trail those expected, with a backlog of around 1150 cSCCs and 11 767 BCCs remaining at the end of the year. ConclusionDiagnosis of keratinocyte carcinoma was suboptimal during the COVID-19 pandemic, due to diagnostic delays likely resulting from both patient and health system-related delay. Further studies will need to determine the effects of these diagnostic delays on outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of the COVID‐19 pandemic on keratinocyte carcinoma in the Netherlands: Trends in diagnoses and magnitude of diagnostic delays

Slotman

Schreuder

Nijsten

et al. 2022

Acad Dermatol Venereol

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“…This large study might reassure our smaller sample and referral pathways being efficient with the 30% detection rate we achieved. Furthermore, it supports and reflects the efforts needed to detect cancerous skin lesions [ 11 ].…”

Section: Discussionmentioning

confidence: 75%

Skin Cancer Excision Analysis in a Single Rural Center in Scotland’s Highlands

Helmy¹,

Al-Nabulsi²,

Chambers³

et al. 2022

Cureus

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Background & AimSkin cancer is the most common cancer around the world. Regional differences have been reported affecting the demographics and the prevalence of non-melanoma skin cancers; furthermore, non-melanoma skin cancers are believed to be underreported. In this study, we aim to identify and highlight any possible significant characteristics of skin cancer in our rural center in Scotland's Highlands. MethodsThis is a retrospective study analyzing and reporting cancerous skin lesions excision rates among all skin lesions excised and their characteristics in our rural center for one year. Clinical and histopathological data for patients attending our services for suspicious skin lesions excision were collected. Data included the patient's age, gender, lesion's diagnosis, site, size, color, borders, resection edges, recurrence, and complications. A database was created creating two cohorts: cancer and non-cancerous lesions groups, both cohorts' data was compared using student T-tests and Z-tests. P-values were considered statistically significant if < 0.5, Overall data was analyzed revealing trends and end results. ResultsFrom December 2019 to December 2020, 96 patients underwent skin lesions excision, 30% were cancerous. Basal cell carcinoma was the most common malignant growth standing for 76.7% of all malignant lesions excised. Squamous cell carcinoma and melanoma were found in 20% and 3.3% of patients with malignant lesions, respectively. Out of the total, 76% of cancerous lesions were in males. The most common site was head and neck (58.8%). High-risk lesions were the ones on the head and neck (P= 0.00988), in the elderly over 74.5 years (P= 0.000037), and males (P= 0.001). ConclusionBasal cell carcinoma was the most common malignant lesion. Elderly men with lesions on the head and neck had higher risks for cancer. Further clarification may be required with larger multi-center studies involving general practitioners, which might help identify regional variations.

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“…Similarly, a prospective, population-based cohort study in Australia found that 12% of all melanomas were incidentally detected and 35% were detected through routine skin checks 15 . In two studies from dermatology hospital clinics in Spain and the UK, as much as 26.6% and 21.7% of all detected skin cancers were detected incidentally 13 . However, these results might not be entirely applicable to the primary care setting, in which the populations are not selected on skin cancer risk.…”

Section: Discussionmentioning

confidence: 99%

“…It has previously been shown that more than 25% of incidental skin cancers could be missed if only LDS is used in the TDS management of patients 12 . In a high-risk population, Omara et al 13 showed that 21.7% of detected skin malignancies in a skin cancer clinic were detected incidentally upon performing a TBSE. Factors that increase the risk of omitting TBSE are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Factors for not performing total body skin examinations in primary care in association with teledermoscopy

Ingvar

Nielsen

Ingvar

2023

Preprint

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Purpose To investigate factors related to omitted total body skin examination (TBSE) in skin cancer diagnostics while managing patients using teledermoscopy (TDS) in Swedish primary care. Methods 4,987 TDS referrals from primary care centers were analyzed to identify factors associated with failing to perform TBSE. Data collected included age, gender of patient and physician, and reason for visit. Logistic regression was used to test the association between the variables and risk for failing to complete a TBSE. Results The risk for omitted TBSE is higher in older patients, females, patients whose primary reason for seeking care was not specifically for a complete skin check, and with female physician. Patients > 80 years had more than four times increased risk not to undergo TBSE compared to the youngest (< 30 y). The strongest correlation to omitting TBSE was with other reason for primary care visit than “skin check”. Male gender of the patient and being examined by male physicians decreased the risk of omitted TBSE by 20% and 30%, respectively. There was no evidence of interaction between the gender of the patient and physician. Conclusion Since TDS reduces the opportunities to have a TBSE by dermatologists, the standard management of patients with suspicious skin lesions in primary care must be revised and evidence-based. TBSE is strongly recommended for patients with increased risk of skin cancer, for example old male persons with fair skin and a history of skin cancer, when managing them with TDS.

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Identification of Incidental Skin Cancers Among Adults Referred to Dermatologists for Suspicious Skin Lesions

Cited by 13 publications

References 41 publications

The impact of the COVID‐19 pandemic on keratinocyte carcinoma in the Netherlands: Trends in diagnoses and magnitude of diagnostic delays

The impact of the COVID‐19 pandemic on keratinocyte carcinoma in the Netherlands: Trends in diagnoses and magnitude of diagnostic delays

Skin Cancer Excision Analysis in a Single Rural Center in Scotland’s Highlands

Factors for not performing total body skin examinations in primary care in association with teledermoscopy

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