Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
Eur J Cancer. 2019 Aug;117:32-40. doi: 10.1016/j.ejca.2019.05.010. Epub 2019 Jun 21.
High incidence rates of keratinocyte carcinoma (KC) in Western countries put pressure on healthcare systems. The aim of this study was to describe clinical practice in order to identify areas for improvement.
A random selection of patients from the Integrated Primary Care Information database who consulted their general practitioner (GP) for suspicious or confirmed KC (n = 1597) was made in the analysis. For secondary care, 1569 patients with histologically confirmed KC were randomly selected from the Netherlands Cancer Registry. All patients were diagnosed between 2009 and 2013 and followed up until 2016. Details on diagnosis, treatment and care during follow-up were described.
Among 942 patients who consulted their GP, KC was included in the working or differential diagnosis, but two-thirds (629) were not KC. If the GP suspected KC, the GP directly referred to a medical specialist in most cases (548 of 942). In half (470 of 967) of all confirmed KCs, a skin malignancy was not described in the initial working or differential diagnosis of the GP. The medical specialist treated the first primary KC in 86% (1369 of 1596) by excision, 4% (69 of 1596) by Mohs surgery and 10% (158 of 1596) by another treatment. Although follow-up is not recommended for low-risk basal cell carcinoma, 83% (29 of 35) received follow-up care. In contrast, 82% (60 of 73) patients with squamous cell carcinoma received less follow-up than recommended.
Strengthening the diagnostic pathway for KC in primary care and reduction of low-value follow-up visits in secondary care seem potential areas for improving the efficiency of KC care.
西方国家角化细胞癌（KC）的高发发病率给医疗保健系统带来了压力。本研究旨在描述临床实践，以确定改进的领域。
在分析中，从综合初级保健信息数据库中随机选择了 1597 名因疑似或确诊 KC 而咨询其全科医生的患者。对于二级保健，从荷兰癌症登记处随机选择了 1569 名经组织学证实的 KC 患者。所有患者均于 2009 年至 2013 年被诊断，并随访至 2016 年。描述了诊断、治疗和随访期间的护理细节。
在 942 名咨询全科医生的患者中，KC 被纳入了工作或鉴别诊断，但三分之二（629 名）不是 KC。如果全科医生怀疑 KC，全科医生通常会直接将患者转介给医学专家（942 名患者中有 548 名）。在所有确诊的 KC 中，有一半（967 名患者中有 470 名），全科医生的初始工作或鉴别诊断中未描述皮肤恶性肿瘤。在 86%（1596 名患者中有 1369 名）的初次原发性 KC 中，医学专家采用切除术进行治疗，4%（1596 名患者中有 69 名）采用 Mohs 手术，10%（1596 名患者中有 158 名）采用其他治疗方法。尽管不建议对低危基底细胞癌进行随访，但仍有 83%（35 名患者中有 29 名）接受了随访护理。相比之下，82%（73 名患者中有 60 名）接受的随访少于推荐的随访次数。
加强初级保健中 KC 的诊断途径，并减少二级保健中的低价值随访，似乎是改善 KC 护理效率的潜在领域。
