The Landscape of Skin Cancer Prevention: A European Survey of Dermatologists’ Practices

Background The global incidence of keratinocyte carcinomas (KCs) is consistently rising. While consensus-based guidelines for active chemoprevention exist (recommending modalities such as oral acitretin, nicotinamide, and photodynamic therapy), their real-world adoption and the rationales driving European dermatologists’ therapeutic choices remain largely unclear. Objectives To evaluate the real-world adoption rates, therapeutic preferences, and underlying decision-making rationales of European dermatologists regarding the active prevention of KCs. Methods A web-based survey was distributed to 9469 active European dermatologists. The survey assessed the frequency of preventive practices, treatment rankings, and the importance of various rationales (e.g., scientific evidence, familiarity, legal status, and affordability) for both adopting and rejecting specific methods. Results Data from 1274 respondents for primary prevention and 517 for secondary prevention (20.1% response rate) were analyzed. Approximately 25% of practitioners seldom or almost never offer active prevention, with significant intercountry variability (p < 0.001). Topical imiquimod emerged as the most popular preventive method, largely outpacing guideline-endorsed systemic options. “Scientific evidence” was the primary rationale for adopting a therapy, whereas “lack of familiarity” was the leading reason for rejection, particularly concerning oral nicotinamide. Lack of access and off-label legal status acted as major deterrents, while potential profitability was the least significant decision factor. A previous KC diagnosis was accompanied by a higher reported frequency of offering active prevention, but we found no evidence that it altered the underlying rationale for method selection. Conclusions Among the participating EADV-affiliated dermatologists, there is a marked discrepancy between current KC chemoprevention guidelines and everyday clinical practice. The preference for topical field therapies over systemic agents is prevalent in this cohort. To optimize healthcare resources and effectively change clinical behavior, efforts must go beyond raising awareness; they must focus on revising educational curricula, improving drug accessibility, and clarifying labeling regulations