Rafael Denadai1, Larissa Kirylko, Luís R M Souto. 1. Division of Plastic Surgery, Department of Surgery, School of Medical Sciences, Universidade de Marília, Marília, São Paulo, Brazil. silva.rdp@hotmail.com.
We read with great interest the recent study by Adinarayan and Krishnamurthy,[1] and although we agree with most of the article's aspects, there are some considerations, which we believe are necessary to make:According to several studies,[23] the authors’[1] assertion that “skin cancers are relatively uncommon malignancies worldwide” seems misplaced. In fact, skin cancer is the most common cancer in humans, being a growing worldwide problem, especially in fair-skinned populations. Therefore, it is considered a global epidemic, leading to a huge demand and increased expenses with health services.[23]Knowledge about the relationship between exposure to ultraviolet radiation and the development of non-melanoma skin cancer (NMSC) has been modified in recent years.[23] Chronic sun exposure seems to be the main cause of squamous cell carcinoma (SCC).[23] In contrast, basal cell carcinoma (BCC) occurs due to intermittent sunlight exposure and history of sunburns, especially during childhood and adolescence.[23] Unlike, therefore, the aspects discussed by the authors.[1]Adinarayan and Krishnamurthy[1] evaluated the distribution of NMSC in different anatomical sites. Related to this, our group[4] and others[5] demonstrated recently that diagnostic accuracy varied according to the affected anatomical area of the body. In both the studies,[45] diagnostic accuracy, when stratified by tumor site, was highest in places where more frequently lesions occur. It is feasible to assume that the behavior learned by doctors causes an excess of malignant lesions’ diagnoses (BCC and SCC) at the respective locations of the body where they most commonly occur, and an underestimation of lesions in body sites where they are less frequent.[5] The domain of this diagnostic aspect is important, considering that the diagnosis of NMSC is predominantly clinical, and it is confirmed by histopathologic evaluation that errors can delay appropriate treatment,[24] it is expected that doctors are able to accurately diagnose these skin lesions.[4] In this context, efforts should be taken to improve medical education regarding these lesions;[5] the diagnostic hypotheses should be based on a set of information (clinical appearance, location, and evolution of lesions) and not just on the anatomical site involved.[45]Finally, we congratulate and thank the authors for their contribution to the clinicopathological understanding and characterization of the NMSC.