Skin cancer

Prevention

Education regarding protection from UV light from childhood onwards
Consider provision of leaflets/posters in surgeries regarding skin protection
Cessation of smoking advice - link with pipe, cigarette smoking in Squamous Cell Carcinoma

Screening

General screening
No screening programme for general population - opportunistic screening of all patients during consultations for other medical problems
Risk directed screening
- BCC- Previous history, family history Gorlin's, organ transplantation, immunosuppression, or previous radiotherapy.
- SCC- Previous history, presence actinic keratosis, Bowen's disease, or immunosuppression.
- Melanoma- History multiple polymorphic moles, family history.

Diagnosis

Symptoms and warning signs that warrant investigation

BCC
- Nodular, pearly papule with central crusting/ulceration, rolled edge, telangiectasia
- Morphology can vary. Consider in any lesion present for months/years particularly on head and neck
SCC
- Scaly papule/nodule which may be crusted or ulcerated and erythematous
- Urgent referral for lesions undergoing rapid growth change and for lesions on lip or ear
Melanoma
- Usually pigmented lesion with a rapid change in size, shape or colour usually > 6mm but not invariably.

Referral

Should contain patient's age; site, size and duration of tumour; clinical features; timescale of change and specific features which have changed
If patient has symptoms as above:
- SCC or Melanoma '2 week rule' applies
- BCC priority referral but outside '2 week rule'

Appropriate investigations pending hospital appointment

No place for diagnostic biopsy in General Practice

Follow up

An explicit follow up policy should be developed for each patient, taking notice of the wishes and interests of the patient and general practitioner. It should be clear to the patient and general practice who is supervising follow up and who to contact if problems arise. Good communication with local Specialist Clinic who may request GP follow-up for uncomplicated BCC/SCC/insitu melanoma.