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Lecturer and Specialty Registrar, Division of Oral and Maxillofacial Surgery, School of Oral and Dental Science, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY
Professor and Consultant in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK
The incidence of skin cancer in the United Kingdom is increasing and is associated with an ageing population and increasing lifetime exposure to sunlight. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and malignant melanoma, all three of which may present on the skin of the face. The dental team are, therefore, well-placed to recognize suspicious lesions and arrange for further advice or assessment. This paper outlines the epidemiology, important clinical features and principles of modern management of facial skin cancers to aid dental practitioners in the recognition of suspicious lesions. In addition, some of these treatments have side-effects which have the potential to affect a patient's oral health or its management and these aspects are also discussed.
Clinical Relevance: The dental surgeon is ideally placed to recognize malignant or potentially malignant lesions on patients' faces and to advise on seeking further advice or refer for assessment, as appropriate. Dental practitioners will increasingly encounter patients who have undergone surgical or non-surgical management of facial skin cancer and should understand the potential oro-facial side-effects of such treatment.
Article
The incidence of skin cancer in the United Kingdom is increasing. Skin cancers are grouped into two categories: malignant melanomas and non-melanoma skin cancers (NMSCs). The melanomas are the least common but most lethal, whilst the much more common NMSCs generally have a better prognosis providing that they are treated appropriately at an early stage. Of the NMSCs, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types and are the only two that will be discussed in detail in this paper.
A knowledge of the basic anatomy of the skin helps illustrate the pathophysiology of skin cancer. The skin is made up of the renewable outer epidermis and the deeper dermis that gives strength and flexibility to the skin. Like the oral mucosa, the epidermis is made up of several cell layers, the most superficial of which is the stratum corneum and the deepest, the basal cell layer. Between the epidermis and dermis is a basement membrane. In addition, skin contains hair, sebaceous and sweat glands and various specialized nerve endings.1 The skin cancers discussed in this paper arise from cells within the epidermis and their relative mortality rates reflect their propensity to breach the basement membrane to cause regional and distant disease.
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