Pre-Malignant Lesions

Solar keratoses

Solar keratoses are extremely common and are usually multiple. The vast majority of solar keratoses do not progress to squamous cell carcinoma and evidence suggests that about 1:500 progress to skin cancer per year. Many will involute following sun protection.

Advice to patients with a few or multiple solar keratoses should be as follows:

1. The use of sun avoidance and sun protection. (See Patient Information pages).

2. Patients should be encouraged to report any changing keratosis to their GP.

3. If treatment is required, the following treatments are appropriate:

a. liquid nitrogen/cryotherapy in general practice

b. Efudix treatment (bd 3 weeks- warn patient re irritation)

c. Solaraze (bd 3 months)

It is not necessary to refer any patient with solar keratoses unless the diagnosis is uncertain or the lesion is no longer flat and is forming a tumour.

Bowen’s Disease

This is carcinoma in situ – intraepidermal squamous cell carcinoma. It produces fixed, flat, red and sometimes scaly patches on the legs particularly, but sometimes elsewhere. It is especially common on the legs of elderly women. A vast majority of Bowen’s lesions do not progress to invasive squamous cell carcinoma and it is not necessary to treat all such lesions.

Advice to patients with Bowen’s Disease should be the same as for solar keratoses. Any lesion that thickens should be treated by cryotherapy or possibly surgically (curettage and cautery or excision), or referred to the dermatology clinic.

It is not necessary to refer patients with Bowen’s Disease unless there is a diagnostic uncertainty or if the lesion is no longer flat and is beginning to form a tumour.

Observation and/or treatment in general practice is quite acceptable for uncomplicated Bowen’ disease.

Malignant Lesions

All patients with basal cell carcinoma or squamous cell carcinoma will require surgical treatment, either in general practice or by referral to the dermatology clinic.

Curettage and cautery or formal excision is often adequate treatment but some tumours will require radiotherapy.