Skin cancer is the most prevalent form of cancer in the United States — a fact that can sound discouraging.
But another fact we know about skin cancer should be encouraging. It is straightforward: One of the best things we can do to prevent and treat skin cancer is simply screen more patients.
This responsibility falls on both patients and their doctors. Patients need to take skin cancer seriously (there are a surprising number who don’t) and make sure they get screened. And doctors need to take every opportunity to look at a patient’s skin, no matter the reason for the visit.
That sort of increased vigilance saves lives.
To see how we can get there, it is helpful to understand why screenings often don’t take place.
Reason 1: The incorrect belief that screenings are unnecessary.
This belief often stems from a 2016 report issued by the U.S. Preventive Services Task Force, a panel of independent medical experts who review evidence about whether or not to recommend particular preventive services in primary care settings.
I wrote about this report and the misunderstandings surrounding it in a previous blog post. The panel concluded that there wasn’t enough evidence to assess the balance of benefits, harms and costs of skin cancer screenings. It absolutely did not recommend against skin cancer screenings.
It might be true that having general healthcare providers conduct full-body skin exams for everyone in the general population does not pass a cost-benefit analysis.
But screenings by a certified dermatologist for patients who are at high risk for skin cancer can be extremely cost-effective. Finding and treating skin cancer early saves millions of healthcare dollars, as doctors can address it with a simple excision instead of chemotherapy, immunotherapy or more invasive surgery.
And it’s important to add that a large segment of the population is at risk for skin cancer. As a starting point, I recommend any caucasian over the age of 50 get screened. But anyone who has a family or personal history of melanoma, had sunburns growing up, used tanning beds, or has a fair complexion has increased risk for skin cancer. If you fall into one of these categories, seeing a dermatologist for a skin check is a good idea.
Reason 2: The misconception that people of color are immune.
It’s true that having more melanin (ie., darker skin) means your skin won’t burn as easily. And if you have more melanin, you usually have fewer moles. That does reduce skin cancer risk.
But it doesn’t eliminate the risk.
And unfortunately, those who believe they are protected from skin cancer don’t use sunscreen nor get screened as frequently. So often when a doctor detects skin cancer in a person of color, the cancer often is more advanced — portending a worse prognosis.
When I speak to groups, I tell them the story of reggae legend Bob Marley. Marley, born in Jamaica in 1945, had a type of melanoma on his pinky toe that was undiagnosed for too long. The cancer eventually spread and he died at age 36.
As physicians, we need to do a better job of fighting the misconception that people of certain ethnicities or skin colors are immune to skin cancer. Skin cancer does not discriminate.
Reason 3: The impression that all skin cancers are easily treatable and less dangerous.
Because skin cancer is so common, many patients know someone who was diagnosed with it and subsequently had it removed with a simple surgery.
That does happen, especially when the cancer is caught early.
But that’s not what happens in every case.
Many skin cancer treatments leave patients with scarring or disfigurements. Healthcare costs for treatment can be high.
And while melanoma is the most rare form of skin cancer (basal cell and squamous cell carcinomas account for 99 percent of skin cancers), it is also the most lethal.
You don’t want to leave it to chance. Early detection and treatment is how you avoid the more dire outcomes.
Screening Often and Opportunistically
Because skin cancer is so common, and many people hold misconceptions about it, it’s important to remember the bottom line: Screening is important and easy.
As I noted above, patients who have risk factors for skin cancer should make sure they get screened.
And the healthcare industry should remember that any doctor can take the opportunity to look at a patient’s skin. In my private dermatology practice, when I see patients for a rash or acne, I always ask to do a skin check as well.
And when I talk to medical residents, I tell them “If you’re going to be listening to somebody’s heart or lungs, lift up the shirt and put your stethoscope on the skin. You might find a melanoma.”
Initial screenings can lead to a smarter approach in the following years. If a dermatologist checks your skin and says that you have no moles and are at low risk, you likely won’t have to get screened again for five years. On the other hand, if the dermatologist finds many moles, they might have you return in three months.
This is the same approach we use for breast and colon cancer detection. We screen, determine risk factors and set a course of action — skin cancer should be no different.
And skin cancer screening can be done with the naked eye, with no blood work or imaging needed.
All of these factors help make the case that everyone should be afforded the opportunity to have a full-body scan for skin cancer. And I’m happy that Inova Saville Cancer Screening & Prevention Center is helping to make this happen.
Patients can come to Saville for skin cancer screenings. But patients who come for other screenings and treatments can be referred to the Center’s dermatologists if doctors discover the signs that they have an increased risk of skin cancer, too.
Instead of telling a patient they should find a dermatologist and make an appointment on their own, our team can send the patient to us, in the building — improving the experience for patients.
Making skin cancer screening easier will encourage more screenings. And with skin cancer, performing more screenings means we can save more lives.