Consultant Dermatological Surgeon, NHS Lothian and Hon Senior Lecturer, University of Edinburgh, Dermatology, Room 4.018, Lauriston Building, Lauriston Place, Edinburgh, EH3 9HA, UK
Skin cancer is the commonest malignancy in most European populations, and is highly treatable. The highest density of tumours is on the face, ears and – if the patient is bald – the scalp. There are two main varieties of skin cancer with very different consequences: melanoma is uncommon but has a significant case-fatality of ~20%, whereas keratinocyte tumours, such as basal cell carcinoma and squamous cell carcinoma, are more common, but have a much better prognosis than melanoma. Diagnosis of skin cancer relies on clinical suspicion and the ability to distinguish the morphologies typical of cancer from the far larger number of benign mimics of skin cancer. Clinical suspicion is paramount in achieving early diagnosis.
Clinical Relevance: Dentists, although their principal activities are confined to the mouth, should be in a position to recognize suspicious skin lesions on the face and other exposed surfaces.
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Most dermatological diagnoses, just like most dental ones, are not fatal and, in general, treatment for skin disease is symptomatic, and based on the ‘here and now’. Unlike much of the work of the modern general medical practitioner, dermatologists are usually concerned with resolving conditions that patients deem important, because they are symptomatic, rather than attempting to prevent some future serious event in a patient who is currently asymptomatic (such as a stroke in somebody who is hypertensive). It follows, that if you as a dentist notice that a patient has a skin disorder, say bad dandruff (essentially a variant of seborrhoeic dermatitis, an inflammatory response to a yeast infection), then the decision to point this out to the patient is perhaps best made on the basis of what you know about the patient already — do you really think they want this issue raising or not? You may reasonably choose to stay quiet.
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