Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Keratinocyte Cancer Working Group.

Timeframes for care

Step in pathway

Care point


Presentation, initial investigations and referral

Signs and symptoms

Presenting symptoms should be promptly and clinically triaged with a health professional

Initial investigations initiated by GP

Investigations and/or curative treatment should be performed within 4 weeks of initial presentation to a GP or as soon as practicable

Referral to specialist

If diagnosis is required, referral to a specialist should be as soon as is practicable according to clinical concern (e.g. 4 weeks for a presumed SCC and 8 weeks for a presumed BCC)

Diagnosis, staging and treatment planning

Diagnosis and staging

Higher risk patients should be prioritised, where clinically indicated

Biopsy should be considered prior to referral, where appropriate

Most patients with keratinocyte cancer only require clinical staging

Multidisciplinary meeting and treatment planning

Selected patients with advanced stage primary keratinocyte cancer, lymph node metastases and keratinocyte cancer in unusual sites are best managed by a multidisciplinary team in a specialist facility

The MDM should be conducted before implementing treatment



Patients will be prioritised, depending on their particular tumour type and extent but will usually be having active treatment within a 3-month period

Radiation therapy

Adjuvant radiation therapy should start as soon as possible once surgical wounds have healed, usually within 4–6 weeks of surgery

Other therapies

Treatment should start as soon as diagnosis and staging has occurred and the treatment modality becomes available, ideally within 4 weeks of the MDM

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

This optimal care pathway covers keratinocyte cancer (cutaneous basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]).

The incidence of treated BCC and SCC is more than five times the incidence of all other cancers combined in Australia. Cancer registries do not routinely report skin cancers apart from invasive melanoma, so exact incidence rates are not known.

The costs of screening and treating these usually non-fatal cancers cause a disproportionately high burden on the Australian health system and have a negative effect on the patient’s quality of life through cosmetic ill-effects such as facial disfigurement. The estimated total treatment cost for non-melanoma skin cancers that was forecasted for 2015 (diagnosis, treatment and pathology) was $703 million (Fransen et al. 2012).

Most patients with keratinocyte cancer will not proceed beyond step 2 because the vast majority of patients can be successfully treated in the primary care setting and will not require further management. For patients who require management beyond step 2, a multidisciplinary approach is indicated.