Basal cell carcinoma follow-up practices by dermatologists: a national survey

BACKGROUND

After treatment of a basal cell carcinoma (BCC) patients are at risk of recurrence of that BCC; also, patients who have had a primary BCC are those who have an increased risk of developing a subsequent primary BCC. However, long-term hospital-based follow-up of all patients would put large strains on the U.K. health service.

OBJECTIVES

To investigate the follow-up intentions of U.K. dermatologists for well-defined facial BCC and to investigate the effect that variations in site and clinical indicators might have on those intentions.

METHODS

A self-completion questionnaire relating to BCC follow-up sent to 388 dermatology consultants and associate specialists in the U.K. had a response rate of 68%. The effects of treatment modality, tumour site, histology, multiple lesions and various patient variables that might alter the likelihood of follow-up were examined. General views on the subject of BCC follow-up were sought.

RESULTS

Twenty-seven per cent of respondents reported that they would not review further after excision of a 'well-defined' BCC from inside a central 'T' area on the face; 37% reported that they would review on one occasion; and 36% reported that they review more than once.

CONCLUSIONS

While it is currently not feasible to follow-up all treated BCCs, a strategy to identify and monitor high-risk patients and a system to gather long-term outcome data prospectively are necessary aspects of a national health service. This study illustrates that the first issue is being addressed to some extent, but at the currently reported level of BCC follow-up in the U.K. there is little scope for collecting comprehensive long-term data on outcomes.

Basal cell carcinoma and risk of subsequent malignancies: A cancer registry-based study in southwest England

BACKGROUND

A possible link between basal cell carcinoma (BCC) and an increased subsequent risk of experiencing further noncutaneous malignancies has been suggested in previous cancer-registry and cohort studies.

OBJECTIVE

The purpose of this study was to establish whether a possible link between BCC and subsequent malignancies could be confirmed in a new population in which environmental and genetic risk factors may vary from previously studied populations.

METHODS

A cohort of 13,961 cancer registry-listed persons from the southwest of England, in whom BCC had been diagnosed during the period of 1981 to 1988, was examined for the relative risk of experiencing various further malignancies.

RESULTS

An approximately 3-fold increase in the risk for malignant melanoma was demonstrated. No other cancers occurred in statistically significant excess.

CONCLUSION

The previous reported associations of BCC onset with subsequent increased risk for various noncutaneous cancers are not supported by this study.

Cutaneous presentation of steroid responsive blastoid natural killer cell lymphoma

CD56+ lymphomas derived from natural killer (NK) cell lineage are rarely encountered in Western populations and their clinical and pathological features have not been fully defined. The majority of reported cases are lymphomas of the nasal cavity, which are most commonly seen in Asia. A subtype of CD56+ lymphoma has recently been described (blastoid NK-cell lymphoma) which characteristically presents in older patients with cutaneous infiltrates and disease at other nodal and extranodal sites. We describe a case that correlates well with the clinicopathological features of blastoid NK-cell lymphoma. An unusual feature in our patient was that the cutaneous features of the lymphoma showed complete resolution shortly following commencement of oral steroid therapy.

Cutaneous Scedosporium apiospermum infection in an immunocompromised patient

Scedosporium apiospermum infection occurred in the left forearm of a patient who was taking oral prednisolone for pulmonary fibrosis. The infection appeared to follow a scratch from a blackcurrant bush. This is the first reported case in the United Kingdom of a cutaneous infection from Scedosporium apiospermum in an immunocompromised patient.