1) Basal cell carcinoma (BCC) is common in Europe and early detection may help reduce costs and morbidity by allowing for less complex and less costly treatment options. 2) The natural course of BCC is known - it grows slowly, has a detectable latent stage, and metastasis is extremely rare. Early detection through methods like naked-eye inspection and dermoscopy may help identify smaller, less advanced lesions. 3) Accepted treatment options exist that are effective and safe for BCC, and screening can help ensure lesions are treated at an earlier stage when options like surgery require smaller margins or less invasive procedures can be used.

1. Is Early Detection of Basal
Cell Carcinoma Worthwhile?
Systematic Review Based on the
WHO Criteria for Screening
British Journal of Dermatology (2016) 174, pp1258-1265
Presented By
Robertus Arian Datusanantyo
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I. Hoorens; K. Vossaert; K. Ongenae; L. Brochez

2. Background
• BCC: common in Europe
• Risk factor (?)
• Diagnosis delay
• WHO criteria for screening
Objective
1. Discuss whether current evidence support early
detection and treatment of BCC to reduce
important morbidity and costs.
2. Address evidence insufficiency in critical areas
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3. WHO Criteria for Screening
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4. Methods
• Applicable studies of BCC:
– Natural history
– Cost of treatment
– Treatment
– Cost-effectiveness
– Cost of illness
• Database:
– PubMed
– Cochrane
– Medline
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5. Important health problem?
• Most common cancer of whites,
increasing rate
• Multiple primary lesion
• Head & neck
– Visibility
– Anatomical complexity
– Direct connection to brain
• Burden for healthcare system
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6. Natural course of BCC is known
• Growth rate
– Slow
– Initial size, male, recurrent tumours
• Histology
– 66 subtypes
– Superficial, fibroepithelial, nodular, infiltrative
• Metastasis
– Extremely rare
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7. Detectable latent stage
• 0.5 mm / 10 weeks (face)
• 0.7 mm / 8.7 weeks (head – neck)
• 2.4 – 3.8 years to reach 10 mm
• Metastasis: rare
• Several years precede metastatic or
giant stage
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8. Suitable screening method: accepted
• Naked-eye inspection
• Dermoscopy
– Improves diagnosis accuracy
– Reduce unnecessary referrals, excicions,
biopsies
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9. Acceptable method of treatment
• Tumour size (>20mm vs <20mm)
• Primary/recurrent, histological
subtype, tumour location
• Surgery: safety margins (3mm, 5mm)
• Mohs micrographic surgery: expensive
• Non-surgical: 5-fluorouracil,
imiquimod, photodynamic therapy
• Destructive: cryosurgery, curretage,
cautery, carbondioxide laser
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10. Provision for diagnosis & treatment
• Naked eye inspection
• Dermoscopy
• Treatment options
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11. Screening: cost effective
• BCC in face:
– More costly
– Higher risk of recurrence
• Size of lesions  indirectly influence
cost
• Cost per primary treatment modality
increases with increasing lesional size
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12. Discussion
• Include BCC in skin cancer screening
initiatives
• Size  complexity, effectiveness, cost of
surgery
• Appropriate selection of initial treatment;
failure  second treatment
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13. Conclusions
• BCC in the facial area fulfills the
majority of the WHO criteria for
screening.
• Early detection and adequate
treatment can reduce treatment
complexity and cost, and offer the
best chance for control.
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14. Thank You!
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