What are the post-procedure care and prevention recommendations for a patient with a history of non-melanoma skin cancer and multiple suspicious lesions?

Post-Procedure Care and Prevention for Non-Melanoma Skin Cancer

Immediate Wound Care

Keep all biopsy sites covered with petrolatum and bandages until fully healed, changing dressings daily. 1

• Apply petrolatum (Vaseline) to all treated areas to prevent crusting and promote healing 1
• Avoid picking at scabs or crusted areas from the liquid nitrogen treatment 1
• Monitor for signs of infection (increasing redness, warmth, purulent drainage, fever) and contact the office immediately if these develop 1
• The provider appropriately used aluminum chloride for hemostasis, which is standard practice 1

Critical Follow-Up Schedule

This patient requires dermatology visits every 6 months for the next 2 years, then annually for life. 1, 2

• The first 2 years post-diagnosis carry the highest recurrence risk, necessitating more frequent surveillance 2
• With this patient's extensive history (melanoma, BCC, SCC, multiple actinic keratoses), he has a 59.6% probability of developing another non-melanoma skin cancer within 10 years 1
• His risk of developing melanoma is 1.99-3.62 times higher than the general population given his non-melanoma skin cancer history 1
• Each visit must include full-body skin examination and palpation of regional lymph node basins 1

Patient Self-Surveillance

Teach this patient monthly self-skin examinations with specific attention to the scalp, back, and other difficult-to-see areas. 1

• Involve his companion/family member in examining areas he cannot easily visualize (back, posterior scalp, posterior shoulders) 1
• Instruct him to look for new lesions that don't heal within 2-3 weeks, changes in existing lesions, or any discoloration arising from previously stable scars 1, 2
• Contact the office immediately for any suspicious findings rather than waiting for scheduled appointments 1

Sun Protection Protocol

This patient must use SPF 30+ broad-spectrum sunscreen daily on all sun-exposed areas, reapplying every 2 hours during outdoor exposure. 1

The provider's documentation notes the patient currently does NOT wear sunscreen—this must change immediately given his high-risk status.

• Apply sunscreen to face, ears, neck, and hands every morning, even on cloudy days 1
• Wear broad-brimmed hats (not baseball caps), long-sleeved shirts, and long pants during outdoor activities 1
• Avoid direct sun exposure between 10 AM and 4 PM when UV radiation is most intense 1
• Seek shade whenever possible and never use tanning beds 1
• Wear UV-protective sunglasses 1

Chemoprevention

Start nicotinamide (Vitamin B3) 500 mg orally twice daily to reduce future skin cancer risk. 1

• This is the only oral chemopreventive agent with evidence supporting its use in patients with history of non-melanoma skin cancer 1
• The provider appropriately recommended this in the visit note 1
• Topical retinoids are NOT recommended as they have not shown benefit and may increase mortality with prolonged use 1

Medication Considerations

Review this patient's anticoagulation regimen (aspirin 81mg + Eliquis 5mg) with the prescribing physician before any future surgical procedures. 1

• The dual anticoagulation increases bleeding risk during dermatologic procedures 1
• For future Mohs surgery or excisions, coordinate with cardiology regarding temporary medication adjustments 1

Critical Pathology Follow-Up

Call the dermatology office in exactly 2 weeks if you have not been contacted with biopsy results. 1

• Five separate specimens were sent for histologic evaluation (locations A-E) 1
• All lesions were clinically suspicious for basal cell carcinoma based on their morphology and locations 1
• Further treatment decisions depend entirely on pathology results—if any show invasive carcinoma, additional excision or Mohs surgery will be necessary 1

Common Pitfalls to Avoid

Do not rely solely on sunscreen—it must be combined with sun avoidance, protective clothing, and behavioral modifications. 2

• Sunscreen alone provides inadequate protection; physical barriers (clothing, shade) are more effective 1, 2
• Do not skip sunscreen on cloudy days—up to 80% of UV radiation penetrates clouds 2
• Do not use sunglasses without adequate UV protection—they can actually increase UV exposure to the eyes by dilating pupils 2
• Do not become complacent after the first 2 years—late recurrences occur, and lifelong surveillance is mandatory 2, 3

Special Consideration for This Patient

Given this patient's age (elderly male), history of stroke, atrial issues, and anticoagulation, he represents the highest-risk demographic for skin cancer mortality. 1 Men over 65 account for 22% of newly diagnosed melanomas but bear disproportionate mortality. 1 His refusal of full-body skin examination during this visit is concerning and should be addressed at the next appointment with emphasis on the life-threatening nature of missed melanomas. 1, 2