title: Awareness of, knowledge of and attitudes to nonmelanoma skin cancer (NMSC) and actinic keratosis (AK) among physicians.
abstract: BACKGROUND
  Nonmelanoma skin cancer (NMSC) is the most common type of cancer that affects the Caucasian population. Approximately 80% of NMSCs are basal cell carcinoma (BCC) and 20% are squamous cell carcinoma (SCC). Actinic keratosis (AK) is a precancerous lesion that may develop into SCC.
  
  
  METHODS
  A market research survey was conducted in which dermatologists and primary care physicians (PCPs) were randomly selected from seven countries (USA, Australia, UK, Italy, France, Germany and Spain). Their knowledge of nonmelanoma skin cancer and their current clinical practice were assessed.
  
  
  RESULTS
  In total, 2100 physicians took part in the survey. They had practised medicine for between 1 and 30 years and saw at least 30 patients in a typical week. The majority of dermatologists (97%) were familiar with BCC and AK, and treated each condition with a minimum of referrals. PCPs were more familiar with BCC (90%) than with AK (74%). Of the PCPs that were aware of BCC, only 31% treated the condition, and of those aware of AK, 40% treated the condition. Surgery was the most common choice of treatment for BCC. The most popular treatment choice for AK lesions was cryotherapy. Eighty to 100% of physicians reported that they discussed skin cancer prevention with their patients. A much lower number of physicians (ranging from 5 to 37%) provided educational material to patients. Overall, PCPs in the two countries that have a high incidence of NMSC (USA and Australia) were more familiar with BCC and AK and more likely to treat each condition than PCPs in Europe. All physicians rated BCC as a more serious condition than AK. Facial lesions were considered more serious than lesions on the head or trunk for both conditions.
  
  
  CONCLUSIONS
  As the burden of disease and the number of patients seeking treatment for NMSC increase, dermatologists are well placed to lead educational initiatives for PCPs and provide educational material for patients. This would increase awareness of AK and BCC and could improve early diagnosis.
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA. halperna@mskcc.org
authors.forename: Allan C
authors.initials: AC
authors.lastname: Halpern
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Hanson
mesh_terms: D001315:Australia / Q000453:epidemiology; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007642:Keratosis / Q000175:diagnosis / Q000473:pathology; D010821:Physicians, Family / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013030:Spain / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology