Assessing physicians’ preferences on skin cancer treatment in Europe

Abstract

SummaryBackground A wide variety of both surgical and nonsurgical therapies is currently available for patients with skin cancer. Objectives This part of the EPIDERM (European Prevention Initiative for Dermatological Malignancies) project is aimed at the evaluation of the treatment preferences for skin cancer in eight countries of the European Union. Methods A multicentre hospital-based case-control study was carried out at dermatology departments in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain. Patients with skin cancer (basal cell carcinoma, actinic keratosis, squamous cell carcinoma, cutaneous malignant melanoma and Bowen disease) were consecutively enrolled between July 2008 and July 2010. Information on the study variables (sex, age, country, tumour type, anatomical location and treatment) was obtained from questionnaires designed by the EPIDERM project. Results In total, 1708 patients with skin cancer were included. Surgery was the first treatment option in 76AE5% of the patients (P = 0AE001). Actinic keratosis was the only tumour type in which nonsurgical treatment was more frequent than surgery (91AE4%). Tumours on the head were less likely to be surgically excised than those at other locations (odds ratio 0AE25, P = 0AE001). Simple excision or curettage was the most common surgical procedure (65AE4%), followed by graft and flaps (22AE4%). Cryotherapy was the most common nonsurgical option (52AE4%), followed by imiquimod (18AE0%), photodynamic therapy (PDT; 12AE0%), 5-fluorouracil (5-FU; 5AE7%), and diclofenac with hyaluronic acid (4AE0%). Conclusions Surgery remains the first-choice treatment of skin cancer. Regarding nonsurgical treatments, the conservative treatments available (imiquimod, PDT and diclofenac gel) have not yet exceeded the use of ablative options such as cryotherapy despite their accepted benefit of treating field cancerization.

The patient journey: a report of skin cancer care across Europe

“…The EPIDERM project investigating skin cancers across Europe 13 has identified and confirmed variations in skin cancer incidence 14,15 and treatment 16 that exist between the participating centres. These variations may be attributed to inherent differences in the populations under study (for example skin colour, dietary variations, sun exposure practices etc.)…”

“…Without the exact prices for reimbursement of the various treatments, we cannot address actual costs of skin cancer to the different health systems. Secondly, we could compare drug prices among the nonsurgical therapies, but the reimbursement cost as well as the true cost of cryotherapy, the most commonly used nonsurgical modality, 16 were difficult to obtain and could not be compared across Europe. Finally, we did not investigate metastasis scenarios despite the importance of these for patient survival, because in several countries (including the U.K., Greece and the Netherlands) metastatic melanoma is in the domain of the oncologists, making it impractical to address this within the framework of this report.…”

Basal cell carcinomas without histological confirmation and their treatment: an audit in four European regions

“…This is especially important as in all four European regions the ratio of dermatologists to the total population is dramatically low, ranging from 1 to 3AE6 per 100 000 inhabitants. 15 In the Netherlands, Scotland and Finland, the preferred treatment modality for histologically confirmed BCC is standard surgical excision, followed by cryotherapy (the Netherlands and Finland) and imiquimod cream (Scotland). No detailed data were available for Malta; however, it seems that most are surgically excised (based on personal communication).…”

Basal Cell Carcinoma Aggressiveness, Molecular Factors And Therapy: A Clinician Perspective

“…The same authors report that at the present time, cryotherapy is the most widely used nonsurgical therapeutic option before pharmacological agents such as imiquimod or photodynamic therapy. The last therapeutic preferences are represented by 5-fluorouraciland diclofenac with hyaluronic acid [18].…”

“…It seems to be the preferred method in cases characterized by the presence of basal cell carcinomas on the face which are not easy amenable to surgery [18]. A very recent study conducted in patients refractory to imiquimod treatment revealed a complete clinical response in most cases (80%).…”