Itch and pain intensity in skin cancer: Why should dermatologic surgeons assess it?

Nonmelanoma skin cancer is the most common type of cancer in the United States. Due to its rising incidence, better screening modalities assessing patient symptomatology are imperative. We reviewed the literature regarding pain and pruritus as presenting clinical manifestations of cutaneous malignancies and elucidate the clinical presentations among skin cancer subtypes. Multiple studies have indicated a higher prevalence of reported pain for squamous cell carcinoma than basal cell carcinoma, but no statistically significant difference was found between these subtypes for itch. Transplant patients, a subset of patients commonly affected with aggressive nonmelanoma skin cancers, ranked the severity of their pain higher in comparison to nontransplant patients. The following cutaneous tumors: keratoacanthomas, infiltration sclerosing BCCs, morpheaform BCCs types and those with perineural invasion, were reported as eliciting the most pain. With the increasing incidence of skin cancer, it is important to recognize the associated presenting clinical manifestations of pruritus and pain, which are shown to be useful in the identification of undiagnosed cutaneous malignancies. Implementation of a numerical rating scale should be considered when evaluating patients with a history of skin cancer or those at high risk, such as transplant recipients.