Early detection of skin cancer in primary care - An experience

Abstract

Background: Skin cancer has an elevated prevalence in Portugal. It is estimated that the incidence of melanoma is 8/100,000 persons/year and the incidence of epitheliomas is 100/100,000 persons/year. The incidence of melanoma has been increasing by 6 to 7% per year. Twenty percent of patients with melanoma will die as a result of their disease and half of these patients will die before the age of 40. The progressive increase in incidence is due not only to an increase in new cases, but also due an increase in consultations. Methodology: This paper reports on a 22-month-long experience (July 2008 to May 2010) of the excision of small skin lesions through minimally invasive surgical procedures. 282 patients of all ages were treated. Of these 58% (164) were female. A total of 341 procedures were performed. Histological examination for diagnostic purposes was performed in 49.8 % (170). Results: The most common lesions observed were epidermal cysts, intradermal melanocytic nevi and compound melanocytic nevi. The following pre-cancerous lesions were also observed: actinic keratosis, cornu cutaneum, HPV lesions, atypical melanocytic nevi, and congenital melanocytic nevus. The following cancerous lesions were observed and excised: squamous cell carcinoma in situ, basal cell carcinoma and melanoma. In all cases of precancerous lesions, complete excision with clear margins was confirmed by histology. All cases of cancerous lesions were referred to secondary care for follow-up and continued treatment. Discussion: It is possible to perform early detection and treatment of skin cancer in primary care. The accessibility of this service is appreciated by patients, allowing for shorter distances travelled to obtain care and reduced waiting times. In future studies, cost-effectiveness and impact on the health of the population should be addressed.