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Red Book

Early detection of cancers

Skin cancer

Guidelines for preventive activities in general practice
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Primary prevention is being ‘sun smart’ (refer to Table 9.4.1.2). Everyone, particularly children, should be advised to adopt protective measures when ultraviolet (UV) levels are ≥3. An RCT in Queensland showed that sunscreen applied daily reduces the incidence of melanoma and squamous cell carcinoma (SCC) in adults with a previous history of skin cancer.58,59

Screening of asymptomatic (low-risk) people for melanoma or non-melanocytic skin cancer (NMSC) is not recommended as there is insufficient evidence available to show that this reduces death.60 A skin cancer screening program in one region of Germany reported temporary reductions in melanoma mortality; however, this ecological study may be subject to several biases.61,62

Instead of screening, providing education that raises awareness of the early signs of skin cancer, particularly in people aged >40 years is recommended. Patients can be assessed opportunistically, or when concerned generally, or about a specific skin lesion.


Advise on sun protection and prevention

Age range chart
0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80
                             

 

Screen increased-risk and high-risk patients

Age range chart
0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80
                               

Clinical assessment of future risk of melanoma should take into account:60

  • patient’s age and sex
  • history of previous melanoma or NMSC
  • number of naevi (common and atypical)
  • family history of melanoma
  • skin and hair pigmentation
  • response to sun exposure
  • evidence of actinic skin damage.

There are no sufficiently well-validated risk models to assess the combined effects of all these factors.63

Skin self-examination should be encouraged for high-risk individuals every three months and clinical examination every six months (B).63,64

Melanocytic skin cancer: Identifying risk

Table 9.4.1.1

Melanocytic skin cancer: Identifying risk
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Table 9.4.1.2

Table 9.4.1.2

Melanocytic skin cancer: Preventive interventions
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Implementation

GPs over-excise pigmented lesions in people who are younger (aged <40 years) or female, in whom they excise more benign lesions.75 GPs should be more suspicious of skin lesions in men aged >50 years.75


Prevention advice

Age range chart
0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80
                             

Opportunistic case finding

Age range chart
0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 >80
                             


High-risk individuals aged ≥40 years should be examined for NMSC opportunistically (B). Skin self-examination should be encouraged for high-risk individuals (B). The most common preventable cause of NMSC is UV exposure. All people, especially children, should be advised to use protective measures when UV levels are ≥3 (A).

An RCT in Queensland showed that sunscreen applied daily reduces the incidence of melanoma and SCC in adults with a previous history of skin cancer.58 In northern Australia and some parts of southern Australia, UV exposure is sufficiently high to require daily use of sunscreen. For daily information about UV levels visit the SunSmart widget

Non-melanocytic skin cancer: Identifying risk

Table 9.4.2.1

Non-melanocytic skin cancer: Identifying risk
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Non-melanocytic skin cancer: Preventive interventions

Table 9.4.2.2

Non-melanocytic skin cancer: Preventive interventions
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