What’s new in skin cancer? An analysis of guidelines and systematic reviews published in 2008–2009

Authors


  • A similar and more detailed review to the material published here appeared in the 2010 Annual Evidence Update on Skin Cancer published by NHS Evidence in March 2009 (http://www.library.nhs.uk/cancer/ViewResource.aspx?resID=312455&tabID=289) and explicit reference is given to that fuller version throughout. There are no copyright issues with using material from that source.

  • Conflict of interest: AEM, DJCG and HCW work in the UK National Health Service (NHS). NHS Evidence – skin disorders is funded by the NHS. None of the authors has any financial connections with any pharmaceutical company.

Professor Hywel Williams, Centre of Evidence Based Dermatology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
E-mail: hywel.williams@nottingham.ac.uk

Summary

This review summarizes clinically important findings from 17 systematic reviews and 2 guidelines on skin cancer indexed between April 2008 and April 2009. Melanoma primary-prevention measures, such as education, are more likely to be successful in younger children than adolescents, and general population screening for melanoma by whole-body examination is not currently supported by the evidence. A large systematic review of melanoma and pregnancy concluded that pregnancy does not affect prognosis. Two systematic reviews imply that sunburn later in life also increases the risk of melanoma, and that it is just as important as sunburn early in life. Three systematic reviews discussed the role of positron emission tomography and sentinel lymph-node biopsy for melanoma staging, but produced conflicting results. Superior diagnostic accuracy of dermatoscopy over naked-eye examination for melanoma was found in one review, while a second implied nonsignificantly higher sensitivity of computer-based diagnostic methods over dermatoscopy for melanoma but with reduced specificity. There were no identified randomized controlled trials of treatments for unresectable recurrent melanoma, and a review of immunotherapy with vaccines for melanoma failed to prove improved overall and disease-free survival. Guidelines for the management of basal cell carcinoma call for risk stratification, based on numerous factors including tumour size, site and histological subtype. Squamous cell carcinoma of the ear has been shown to spread to regional lymph nodes more commonly than to other sites, and may be predicted by depth of invasion, tumour size, cellular differentiation and completeness of excision.

Ancillary