Halpern Allan C, Hanson Laura J
Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Int J Dermatol. 2004 Sep;43(9):638-42. doi: 10.1111/j.1365-4632.2004.02124.x.
Nonmelanoma skin cancer (NMSC) is the most common type of cancer that affects the Caucasian population. Approximately 80% of NMSCs are basal cell carcinoma (BCC) and 20% are squamous cell carcinoma (SCC). Actinic keratosis (AK) is a precancerous lesion that may develop into SCC.
A market research survey was conducted in which dermatologists and primary care physicians (PCPs) were randomly selected from seven countries (USA, Australia, UK, Italy, France, Germany and Spain). Their knowledge of nonmelanoma skin cancer and their current clinical practice were assessed.
In total, 2100 physicians took part in the survey. They had practised medicine for between 1 and 30 years and saw at least 30 patients in a typical week. The majority of dermatologists (97%) were familiar with BCC and AK, and treated each condition with a minimum of referrals. PCPs were more familiar with BCC (90%) than with AK (74%). Of the PCPs that were aware of BCC, only 31% treated the condition, and of those aware of AK, 40% treated the condition. Surgery was the most common choice of treatment for BCC. The most popular treatment choice for AK lesions was cryotherapy. Eighty to 100% of physicians reported that they discussed skin cancer prevention with their patients. A much lower number of physicians (ranging from 5 to 37%) provided educational material to patients. Overall, PCPs in the two countries that have a high incidence of NMSC (USA and Australia) were more familiar with BCC and AK and more likely to treat each condition than PCPs in Europe. All physicians rated BCC as a more serious condition than AK. Facial lesions were considered more serious than lesions on the head or trunk for both conditions.
As the burden of disease and the number of patients seeking treatment for NMSC increase, dermatologists are well placed to lead educational initiatives for PCPs and provide educational material for patients. This would increase awareness of AK and BCC and could improve early diagnosis.
非黑色素瘤皮肤癌(NMSC)是影响白种人群的最常见癌症类型。大约80%的非黑色素瘤皮肤癌是基底细胞癌(BCC),20%是鳞状细胞癌(SCC)。光化性角化病(AK)是一种可能发展为鳞状细胞癌的癌前病变。
开展了一项市场调研,从七个国家(美国、澳大利亚、英国、意大利、法国、德国和西班牙)随机选取皮肤科医生和初级保健医生(PCP)。评估他们对非黑色素瘤皮肤癌的了解情况以及当前的临床实践。
共有2100名医生参与了此次调研。他们的行医年限在1至30年之间,且在典型的一周内至少接诊30名患者。大多数皮肤科医生(97%)熟悉基底细胞癌和光化性角化病,并且在转诊最少的情况下治疗每种病症。初级保健医生对基底细胞癌(90%)的熟悉程度高于对光化性角化病(74%)的熟悉程度。在知晓基底细胞癌的初级保健医生中,只有31%对该病症进行治疗;在知晓光化性角化病的医生中,40%对该病症进行治疗。手术是基底细胞癌最常见的治疗选择。光化性角化病病变最常用的治疗选择是冷冻疗法。80%至100%的医生报告称他们会与患者讨论皮肤癌预防问题。提供教育材料给患者的医生数量要少得多(从5%到37%不等)。总体而言,非黑色素瘤皮肤癌发病率较高的两个国家(美国和澳大利亚)的初级保健医生比欧洲的初级保健医生更熟悉基底细胞癌和光化性角化病,并且更有可能治疗每种病症。所有医生都认为基底细胞癌比光化性角化病病情更严重。对于这两种病症,面部病变都被认为比头部或躯干的病变更严重。
随着疾病负担以及寻求非黑色素瘤皮肤癌治疗的患者数量增加,皮肤科医生非常适合牵头针对初级保健医生的教育举措,并为患者提供教育材料。这将提高对光化性角化病和基底细胞癌的认识,并可能改善早期诊断。