Assessing the reasons for late presentation skin cancers – what can we do about them?

Abstract

Background. An increasing number of patients are presenting to tertiary hospitals with advanced-stage skin cancers that require extensive extirpative surgery and complex surgical reconstructions.

Objective. To determine the incidence and reasons for patients presenting late with advanced non-melanoma skin cancer (NMSC). Methods. A prospective cohort study was carried out in a tertiary plastic surgery unit in the Eastern Cape Province, South Africa. Eligible subjects were 77 patients presenting with new NMSC between January and July 2019. The survey instrument was a one-page doctor-administered questionnaire eliciting patient medical history, skin cancer history, demographic information, initial and subsequent lesion size and reasons for delay in presentation for evaluation and management.

Results. Basal cell carcinomas (BCCs) and squamous cell carcinomas are the most and second-most common forms of skin cancer worldwide. In this study, 51 (66.2%) patients had a delay >3 months. This study showed a predominance of white subjects (79.2%) and a mean age >65 years. The male-to-female ratio was 1:0.75, and the majority of patients had BCCs (67.5%). The majority of patients attributed the delay to reasons that correspond with denial and fear: lack of realisation of the seriousness of the lesion (49%), and being scared or embarrassed about what the doctor might find (37.3%).

Conclusion. This study confirms that patients present late with NMSCs. Possible interventions of patient screening and education, improvement in undergraduate teaching and protocolised primary healthcare could decrease the incidence of late presentation skin cancer, with patient benefits and cost benefits to the healthcare system.