1.3 Early detection

1.3 Early detection

There is no evidence that population-based screening for keratinocyte cancer is effective in reducing morbidity or mortality, and it is not recommended.

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

Management of all patients should include:

  • education about skin awareness and encouragement of regular self-examination
  • education about skin cancer prevention for the person at risk and their family
  • education about average, increased and high-risk patient factors.

For most patients, screening is opportunistic, unless patients are in a high-risk category, whereby six to 12-monthly reviews with an adequately trained and experienced clinician is warranted. High-risk patients include those with:

  • a history of keratinocyte cancer – up to 60 per cent of patients will develop another primary keratinocyte cancer within three years
  • a previous melanoma
  • immunosuppression (e.g. post-transplant)
  • certain genetic syndromes (e.g. Gorlin’s syndrome)
  • past exposure to arsenic.

Total body skin examination of patients should be practised by a practitioner with adequate training and experience (Cancer Council Australia Keratinocyte Cancers Guideline Working Party 2019). An agreed scope of practice in keratinocyte cancers (SCCs/BCCs) is required of practitioners undertaking screening or treatment of these cancers.

Skin cancer clinics are accessible without a Medicare Benefits Schedule (MBS) referral in Australia, and are generally staffed by general practitioners with a special interest in skin cancers. Documented evidence of the practitioner’s further experience and training in skin cancers should be available.

Refer to The Red Book for further primary care specific information.