Non-melanoma skin cancer: United Kingdom National Multidisciplinary Guidelines

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence.Recommendations• Royal College of Pathologists minimum datasets for NMSC should be adhered to in order to improve patient care and help work-force planning in pathology departments. (G)• Tumour depth is of critical importance in identifying high-risk cutaneous squamous cell carcinoma (cSCC), and should be reported in all cases. (R)• Appropriate imaging to determine the extent of primary NMSC is indicated when peri-neural involvement or bony invasion is suspected. (R)• In the clinically N0 neck, radiological imaging is not beneficial, and a policy of watchful waiting and patient education can be adopted. (R)• Patients with high-risk NMSC should be treated by members of a skin cancer multidisciplinary team (MDT) in secondary care. (G)• Non-infiltrative basal cell carcinoma (BCC) <2 cm in size should be excised with a margin of 4–5 mm. Smaller margins (2–3 mm) may be taken in sites where reconstructive options are limited, when reconstruction should be delayed. (R)• Where there is a high risk of recurrence, delayed reconstruction or Mohs micrographic surgery should be used. (R)• Surgical excision of low-risk cSCC with a margin of 4 mm or greater is the treatment of choice. (R)• High-risk cSCC should be excised with a margin of 6 mm or greater. (R).• Mohs micrographic surgery has a role in some high-risk cSCC cases following MDT discussion. (R)• Delayed reconstruction should be used in high-risk cSCC. (G)• Intra-operative conventional frozen section in cSCC is not recommended. (G)• Radiotherapy (RT) is an effective therapy for primary BCC and cSCC. (R)• Re-excision should be carried out for incompletely excised high-risk BCC or where there is deep margin involvement. (R)• Incompletely excised high-risk cSCC should be re-excised. (R)• Further surgery should involve confirmed marginal clearance before reconstruction. (R)• P+ N0 disease: Resection should include involved parotid tissue, combined with levels I–III neck dissection, to include the external jugular node. (R)• P+ N+ disease: Resection should include level V if that level is clinically or radiologically involved. (R)• Adjuvant RT should include level V if not dissected. (R)• P0 N+ disease: Anterior neck disease should be managed with levels I–IV neck dissection to include the external jugular node. (R)• P0 N+ posterior echelon nodal disease (i.e. occipital or post-auricular) should undergo dissection of levels II–V, with sparing of level I. (R)• Consider treatment of the ipsilateral parotid if the primary site is the anterior scalp, temple or forehead. (R)• All patients should receive education in self-examination and skin cancer prevention measures. (G)• Patients who have had a single completely excised BCC or low-risk cSCC can be discharged ...

A Network Meta‐Analysis of Non‐Melanoma Skin Cancer (NMSC) Treatments: Efficacy and Safety Assessment

“…PDT was also proved to be better than the traditional intervention FU [Salim et al, 2003;Morton et al, 2006] with regard to CLC, CLR, CRP, and AEs in treating the SCC subgroup of NMSC. Meanwhile, SE with a predetermined margin is the treatment recommended by United Kingdom National Multidisciplinary Guidelines of NMSC for the majority of both BCCs and SCCs [Newlands et al, 2016], which is also consistent with our study. This might be attributed to the particular patient background (SCC and BD subgroups) in the above publications.…”

Elective neck dissection in metastatic cutaneous squamous cell carcinoma to the parotid gland: A systematic review and meta‐analysis

“…In those that commented on specific levels, a supraomohyoid neck dissection (levels I‐III) was typically recommended, with level V if the primary CSCC was of the neck or posterior scalp. This is in line with the recently published United Kingdom National Multidisciplinary Guidelines which recommend selective dissection of levels I, II, and III, including external jugular nodes, for cP+N0 head and neck SCC . Ebrahimi et al (the largest cP+N0 series) went on to recommended omission of level I providing disease was not associated with a facial primary CSCC and the perifacial nodes were taken as part of the marginal nerve dissection during parotidectomy …”

Ocular basal cell carcinoma: a brief literature review of clinical diagnosis and treatment

“…The UK National Multidisciplinary Guidelines recommend that non-infiltrative BCCs <2 cm should be excised with a margin of 4–5 mm. Smaller margins (2–3 mm) may be taken in case of limited reconstructive options 23. The involvement of the eyelid margin makes surgical reconstruction more difficult.…”