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The following is a summary of “St Andrews Referral Delay in Skin Cancer (StARDISC): A study of keratinocyte skin cancer time to treatment, growth, invasiveness, British Association of Dermatologists risk factors and excision adequacy,” published in the March 2025 issue of British Journal of Dermatology by Miranda et al. 

Despite differing British Association of Dermatologists (BAD) guidelines for basal (BCC) and squamous (SCC) cell skin carcinomas, there’s limited data on their histopathological progression over time to inform management.  

Researchers conducted a retrospective study to examine the impact of lesion duration on keratinocyte skin cancer (KSC) growth, high-risk factors per BAD guidelines, and excision margin adequacy.  

They analyzed a random sample of individuals with BCC and SCC referred to a Plastic Surgery Skin Cancer Centre from January to June 2019. Data included demographics, referral sources, lesion duration (from first appearance to treatment), histological findings, excision margins, and skin cancer risk per BAD guidelines.  

The results showed that 728 individuals (397 male, 331 females, median age = 77 years) underwent 872 KSC excisions, including 454 BCC and 418 SCC. Longer lesion duration correlated with increased BCC (P < 0.001, P = 0.001) and SCC (P < 0.001, P < 0.001) surface area and thickness in multivariable regression. The likelihood of very-high-risk histological features in SCC increased with lesion duration, including diameter >40 mm (P < 0.001), thickness >6 mm (P < 0.001), and total number of very-high-risk factors (P < 0.001). The SCCs present for over 3 months had greater median surface area (706.9 mm² vs 295.3 mm²; P < 0.001) and thickness (3.5 mm vs 3 mm; P < 0.001) compared to those present for ≤3 months. Similarly, BCCs with longer lesion duration had a larger median surface area (263.9 mm² vs 131.9 mm²; P < 0.001). A trend of decreasing BCC and SCC excision adequacy was observed with an increasing number of high or very-high-risk parameters.  

Investigators concluded that lesion duration increased SCC thickness and high-risk features, impacting surgical margins and supporting current BAD guidelines for identifying high-risk keratinocyte skin cancers. 

Source: academic.oup.com/bjd/advance-article-abstract/doi/10.1093/bjd/ljaf097/8075159