Disease management for chronic skin cancer

Worldwide non-melanoma skin cancer (NMSC) is a rapidly rising problem. In this thesis we show that an enormous gap exists between the official first primary figures available at cancer registries and the actual burden in a dermatology practice. NMSC needs to be regarded as a chronic disease and should be managed with help of a disease management system, as we describe in this thesis. A disease management system that organises health care for one well-documented health care problem uses a systematic approach. This includes prevention, education, multidisciplinary care, information technology, and management. We performed studies on innovations in the treatment and treatment processes of chronic skin cancer patients. Treatments that can be performed by the patients themselves, outside the hospital will reduce the workload at the clinic. The use of imiquimod 5% cream as a pre-treatment of Mohs’ micrographic surgery resulted in a more effective and efficient treatment. We demonstrated a more efficient treatment process with help of a one-stop-shop treatment for basal cell carcinomas. This resulted in a high patient satisfaction as well. Finally, we created a NMSC detection model and showed that dermatology nurses can contribute in diagnosing NMSC.

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