Prevention

• Solar radiation is the major environmental cause of all skin cancers. People should be encouraged to use a combination of sun protection measures whenever UV index levels are 3 or above (during sun protection times).
• Quit smoking.
• Don’t use solariums.

Risk factors

• Environmental and exogenous risk factors:
• chronic sun exposure
• multiple solar keratoses
• solarium use
• intensive UV exposure in childhood and adolescence
• past exposure to arsenic.

Personal risk factors:

• some rare genetic conditions predisposing to skin cancer
• skin types I and II
• a history of blistering sunburn
• increasing age
• a previous melanoma or BCC/SCC
• solar keratoses.

Lifestyle risk factors:

• outdoor occupations
• recreational sun exposure.

Medical risk factors:

• UVA and psoralen (PUVA) treatment for psoriasis
• immunosuppression
• previous radiotherapy
• some photosensitising medications.

Screening recommendations

The patient’s first point of contact for detecting keratinocyte cancer early should be their GP.

Early detection

Management of all patients should include education about skin awareness and encouraging regular self-examination, education about skin cancer prevention for the person at risk and their family, and education about average, increased and high-risk patient factors.

For most patients, screening is opportunistic, unless patients are in a high-risk category, whereby 6–12-monthly reviews with an adequately trained and experienced clinician is warranted. See the optimal care pathway for keratinocyte cancer for patients considered at high-risk.

Checklist