Is early detection of basal cell carcinoma worthwhile? Systematic review based on the WHO criteria for screening

Abstract

The incidence of basal cell carcinoma (BCC) has risen three- to fourfold over the last 30 years and is expected to continue to increase with ageing of the population. Although BCC has a good prognosis, it causes significant morbidity and has an important impact on the public health budget due to direct treatment costs. Based on the existing evidence, a systematic evaluation of the World Health Organization criteria was performed to determine whether earlier detection of BCC could reduce morbidity and cost. BCC slowly increases in size, with a median increase in diameter of 0·5 mm over 10 weeks. There is an important delay in diagnosis ranging from 19 to 25 months. In several studies BCC size was the main determinant of treatment cost, surgical complexity, reconstruction technique and the specific surgical procedure performed, such as Mohs micrographic surgery or surgical excision. One study showed that size also seems to affect the cost per treatment for other nonsurgical options. The use of vismodegib, an inhibitor of the hedgehog pathway, is confined to locally advanced or metastatic BCC. Delays in diagnosis and appropriate treatment are the most important underlying causes in the occurrence of giant BCC and/or BCC with metastasis. Although the latter represent only a very small fraction of all BCCs, the majority of them are located in the facial region. The available data point to a slow increase in the size of BCCs over time. Size is one of the major determinants in choice of treatment and the associated cost, especially for facial BCC. Therefore we conclude that current data support early detection and adequate management of BCCs on the face.

Interrater and intrarater agreement of confocal microscopy imaging in diagnosing and subtyping basal cell carcinoma

“…Of those techniques, in vivo reflectance confocal microscopy (RCM) seems very promising as the procedure enables inspection of the whole lesion while the morphologic features are similar to routine histology . If RCM would be able to accurately diagnose and subtype BCC, not only the amount of painful invasive skin biopsies could be reduced but also the time delay between diagnosis and treatment, administrative workload and healthcare costs . Yet prior to replacement of routine punch biopsies, a critical appraisal of the diagnostic RCM procedure is needed.…”

One‐stop‐shop with confocal microscopy imaging vs. standard care for surgical treatment of basal cell carcinoma: an open‐label, noninferiority, randomized controlled multicentre trial

“…This study seems relevant to the rising number of BCCs seen in clinical dermatology practice. Although BCC has a good prognosis, delay in diagnosis and appropriate treatment may result in extra public health costs . Noninvasive imaging techniques such as RCM can aid in earlier detection of BCC as opposed to painful routine skin biopsies, even in BCCs that are invisible to the naked eye .…”

“…Although BCC has a good prognosis, delay in diagnosis and appropriate treatment may result in extra public health costs. 16 Noninvasive imaging techniques such as RCM can aid in earlier detection of BCC as opposed to painful routine skin biopsies, 17 even in BCCs that are invisible to the naked eye. 18 In addition to early diagnosis, another important advantage of the RCM one-stop-shop is direct treatment for patients with BCC.…”

Treatment of Actinic Keratoses Facilitates Dermatoscopic Diagnosis of Early Basal Cell Carcinoma: A Case Report and Review

“…Both AK and BCC can cause high morbidity and treatment costs, especially if diagnosis and treatment is delayed thus allowing BCC to increase in size and possibly to a more aggressive subtype [14, 15] and AK to progress towards invasive SCC. Therefore, early diagnosis and management has a crucial role.…”