title: Head and neck nonmelanoma cutaneous malignancy treatment in a skin cancer referral center.
abstract: OBJECTIVE
  The purpose of our study was to determine the level of accuracy provided by clinical diagnosis in head and neck cutaneous malignancy as confirmed by histopathologic examination of the specimen in a skin cancer referral center. Positive predictive value was selected as a reliable measure of diagnostic accuracy. We also aimed to audit our surgical outcomes and record and present the completeness of excision, the rates of recurrence and metastasis, and the reconstructive method.
  
  
  METHODS
  We reviewed the electronic charts of 867 consecutive patients with skin tumors and calculated the positive and negative predictive values of clinical diagnosis.
  
  
  RESULTS
  The positive predictive value was 91% for basal cell carcinoma and 78.8% for squamous cell carcinoma. Of the 178 histologically diagnosed squamous cell carcinomas, 15 were metastatic.
  
  
  CONCLUSIONS
  In a skin cancer referral center, expert clinical diagnosis may safely overcome the need for preoperative biopsy. Relying on clinical diagnosis to formalize a treatment plan for head and neck nonmelanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma compared with suspected squamous cell carcinomas.
authors.affiliation: Oral and Maxillofacial Surgeon, Northampton General Hospital, UK. Electronic address: Pan_stath@yahoo.gr.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Stathopoulos
authors.affiliation: Oral and Maxillofacial Surgeon, Biostatistics, Heraklion General Hospital, Greece.
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Igoumenakis
authors.affiliation: Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK.
authors.forename: James
authors.initials: J
authors.lastname: Shuttleworth
authors.affiliation: Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Frawley
authors.affiliation: Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK.
authors.forename: Ciara
authors.initials: C
authors.lastname: Ennis
authors.affiliation: Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Battista
authors.affiliation: Consultant Oral and Maxillofacial Surgeon, Northampton General Hospital, UK.
authors.forename: Phillip
authors.initials: P
authors.lastname: Ameerally
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002280:Basal Cell Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000379:methods; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome