A systematic review of clinical practice guidelines revealed substantial variation in recommendations for follow-up after initial treatment for keratinocyte carcinoma. The findings were published in JAMA Dermatology.

The guideline recommendations ranged from no follow-up visit after treatment to regular follow-up visits for the rest of the patient’s life. 

This review included guidelines about the management of cutaneous squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) published between January 2010 and March 2022.


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A total of 14 guidelines met the inclusion criteria. The guidelines provided recommendations for BCC only (n=7), SCC only (n=6), or both (n=1). The guideline organizations were from Europe (n=8), North America (n=5), and Australia (n=1).

BCC Recommendations

In the 8 guidelines addressing BCC, 3 provided general recommendations for all patients with newly treated BCC, not stratified by risk of recurrence. 

Two of the general guidelines recommended that patients undergo annual follow-up, and the third recommended that patients have a follow-up visit every 6 to 12 months for 5 years, followed by annual visits. Two of the 3 guidelines recommended life-long surveillance, while the third did not specify the duration of follow-up.

The remaining 5 guidelines provided follow-up recommendations stratified by recurrence risk. 

For low-risk BCC, 2 guidelines recommended that patients undergo annual follow-up, and 1 guideline recommended a primary follow-up at 6 months followed by yearly exams. One guideline recommended a single follow-up visit, and the remaining guideline indicated that no follow-up skin exam was needed. 

For high-risk BCC, 4 of 5 guidelines recommended follow-up every 6 to 12 months. One guideline recommended follow-up every 3 months for 2 years, followed by every 12 months. Two guidelines said follow-up should last a minimum of 3 to 5 years, 1 guideline suggested 5 to 10 years of follow-up, and 2 did not specify the duration of follow-up.

The specific guidelines about what a BCC follow-up visit should entail were relatively consistent across guidelines, comprising a skin examination as well as counseling about sun protection and skin self-exams.

SCC Recommendations

For SCC, 1 guideline gave general advice that all patients should undergo annual follow-up, with no specified duration. The remaining 6 guidelines based recommendations on patient risk. 

For low-risk SCC, 1 guideline recommended a single follow-up visit, 2 recommended follow-up every 6 to 12 months, and 2 suggested annual follow-up. The remaining guideline recommended follow-up every 3 to 12 months for 2 years, followed by every 6 to 12 months for another 3 years, and yearly thereafter for the patient’s life span. 

For high-risk SCC, 3 guidelines recommended follow-up every 3 to 6 months for the first 2 years, then every 6 to 12 months for 3 years, and annual follow-up thereafter. The fourth guideline recommended follow-up visits every 4 months for the first year and every 6 months for the second year. The fifth guideline recommended follow-up every 3 to 6 months for at least 5 years. 

The sixth guideline recommended annual follow-up for all SCC patients except for those whose tumors were moderately or poorly differentiated or located on the lip or ear. For these patients, who were considered to be higher-risk, the guideline recommended follow-up once at 3 months and then every 6 months. 

Of the 5 guidelines that contained recommendations regarding duration of follow-up, 1 recommended 2 years, 1 recommended at least 5 years, 1 recommended 10 years, and 2 recommended life-long surveillance. 

The components of these SCC follow-up visits were variable. All SCC guidelines recommended a skin examination, and 5 suggested a lymph node examination. Four guidelines recommended imaging surveillance for patients with high risk, including 3 guidelines that recommended lymph node ultrasonography if indicated.

“The findings of this systemic review highlight variations in follow-up recommendations for patients after initial treatment for KC [keratinocyte carcinoma],” the researchers wrote. “Randomized clinical trials are needed to define an optimal follow-up regimen.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Mirali S, Tang E, Drucker AM, et al. Follow-up of patients with keratinocyte carcinoma: A systematic review of clinical practice guidelines. JAMA Dermatol. Published online November 2, 2022. doi:10.1001/jamadermatol.2022.4590