Treatment of non-melanoma skin cancer: a review of recent trends with special reference to the Australian scene.

Non-melanoma skin cancer (NMSC) is rarely recorded in cancer registries and it is only relatively recently that the serious public health implications, especially in terms of morbidity and expense, have been appreciated. Increased recreational sun exposure (particularly among the young) and ozone layer depletion have generated concern in many countries. Histological confirmation of the diagnosis, either by excision biopsy or punch biopsy is essential if management of the condition is to be rational and the results assessed. Surgery or radiotherapy or other dermatological techniques will cure over 90% of all NMSC. Comparison of the results of various modalities is difficult and poorly documented. Local recurrence rates of 2.0% for surgery and 3.7% for superficial X-ray treatment (SXRT), with 96% and 90% 5-year failure-free-survival respectively are reported from the Peter MacCallum Cancer Institute. More comparative trials are required with good cosmetic and late normal tissue damage evaluation. Factors affecting modality choice trends in Australia are discussed, where the role of plastic surgery has considerably expanded. The indications for radiotherapy and its fractionation require clarification, as does the use of moulds and implants. The belief that solar keratoses transform to invasive cancer has been seriously brought into question by recent Australian epidemiological studies. There can, however, be little doubt of the fact that keratoses are markers of cumulative solar damage, which is a well recognised risk factor for development of NMSC. There is a move away from aggressive ablative treatment of keratoses. The management of keratoacanthoma (KA) by observation is the usual practice, although radiotherapy is occasionally used when the lesion is conspicuous and unsightly.(ABSTRACT TRUNCATED AT 250 WORDS)