Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patientoriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy (SORT) evidence rating system, go to https://www.aafp.org/afp/2004/0201/p548.html.

1. Advise patients to use a broad-spectrum, water-resistant sunscreen with sun protection factor (SPF) of at least 30 and reapply sunscreen every 2 hours to protect against UVA and UVB exposure in the prevention of skin cancer.
Evidence rating: SORT C
Sources: Section One, reference 5, 7, 20, 56, and 58

2. Incorporate dermoscopy in clinical practice to improve diagnostic accuracy for skin cancers, particularly basal cell carcinoma and melanoma.
Evidence rating: SORT B
Sources: Section Two, references 2-6

3. For nonmelanoma skin cancers, no single biopsy technique has demonstrated superiority; therefore, clinicians may select shave, punch, excisional, or incisional techniques based on lesion characteristics and patient factors.
Evidence rating: SORT C
Source: Section Two, reference 19

4. All skin lesions suspicious for melanoma should be evaluated with narrow excisional (complete) biopsy, including 1- to 3-mm margins and the entire base of the lesion. Elliptical (fusiform) excision, punch excision (if it can encompass the entire lesion), or saucerization (deep shave) can be used.
Evidence rating: SORT B
Sources: Section Two, references 34 and 42

5. For low-risk basal cell carcinomas, if standard surgical excision is performed, a margin of at least 4 mm is advised. For high-risk basal cell carcinomas or those in cosmetically or functionally sensitive areas, referral to a dermatologist for Mohs surgery is recommended for best clinical outcomes.
Evidence rating: SORT B
Sources: Section Three, references 26 and 29

6. Consider referring patients with melanoma and a Breslow depth of 0.8 mm or greater to surgical oncology for sentinel lymph node biopsy after discussion of risks and benefits.
Evidence rating: SORT C
Sources: Section Four, references 7 and 11