title: Assessing physicians' preferences on skin cancer treatment in Europe.
abstract: BACKGROUND
  A wide variety of both surgical and nonsurgical therapies is currently available for patients with skin cancer.
  
  
  OBJECTIVE
  This part of the EPIDERM (European Prevention Initiative for Dermatological Malignancies) project is aimed at the evaluation of the treatment preferences for skin cancer in eight countries of the European Union.
  
  
  METHODS
  A multicentre hospital-based case-control study was carried out at dermatology departments in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain. Patients with skin cancer (basal cell carcinoma, actinic keratosis, squamous cell carcinoma, cutaneous malignant melanoma and Bowen disease) were consecutively enrolled between July 2008 and July 2010. Information on the study variables (sex, age, country, tumour type, anatomical location and treatment) was obtained from questionnaires designed by the EPIDERM project.
  
  
  RESULTS
  In total, 1708 patients with skin cancer were included. Surgery was the first treatment option in 76·5% of the patients (P = 0·001). Actinic keratosis was the only tumour type in which nonsurgical treatment was more frequent than surgery (91·4%). Tumours on the head were less likely to be surgically excised than those at other locations (odds ratio 0·25, P = 0·001). Simple excision or curettage was the most common surgical procedure (65·4%), followed by graft and flaps (22·4%). Cryotherapy was the most common nonsurgical option (52·4%), followed by imiquimod (18·0%), photodynamic therapy (PDT; 12·0%), 5-fluorouracil (5-FU; 5·7%), and diclofenac with hyaluronic acid (4·0%).
  
  
  CONCLUSIONS
  Surgery remains the first-choice treatment of skin cancer. Regarding nonsurgical treatments, the conservative treatments available (imiquimod, 5-FU, PDT and diclofenac gel) have not yet exceeded the use of ablative options such as cryotherapy despite their accepted benefit of treating field cancerization.
authors.affiliation: Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain. lferrandiz@e-derma.org
authors.forename: L
authors.initials: L
authors.lastname: Ferrandiz
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-de-Casas
authors.forename: M
authors.initials: M
authors.lastname: Trakatelli
authors.forename: E
authors.initials: E
authors.lastname: de Vries
authors.forename: M
authors.initials: M
authors.lastname: Ulrich
authors.forename: S
authors.initials: S
authors.lastname: Aquilina
authors.forename: O
authors.initials: O
authors.lastname: Saksela
authors.forename: S
authors.initials: S
authors.lastname: Majewski
authors.forename: A
authors.initials: A
authors.lastname: Ranki
authors.forename: C
authors.initials: C
authors.lastname: Proby
authors.forename: C
authors.initials: C
authors.lastname: Magnoni
authors.forename: S
authors.initials: S
authors.lastname: Pitkänen
authors.forename: K
authors.initials: K
authors.lastname: Kalokasidis
authors.forename: S
authors.initials: S
authors.lastname: Siskou
authors.forename: B
authors.initials: B
authors.lastname: Hinrichs
authors.forename: E
authors.initials: E
authors.lastname: Altsitsiadis
authors.forename: E
authors.initials: E
authors.lastname: Stockfleth
authors.forename: D
authors.initials: D
authors.lastname: Moreno-Ramirez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D003880:Dermatology; D005060:Europe; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000523:psychology / Q000628:therapy*