Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives  for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, she reaches out to Anetta Reszko, a dermatologist in New York City who is affiliated with NewYork–Presbyterian Hospital/Weill Cornell Medical Center—and is a member of our Medical Advisory Board—for answers to a question about detecting early signs of skin cancer.

Dear Dr. Pat:

My sister was just diagnosed with invasive squamous cell cancer on the back of her thigh.  It is now a big deal, with massive surgery and maybe lymph nodes.  She has seen a dermatologist for the last seven years three times a year for “cosmetic” stuff.  She assumed that the dermatologist was “checking her skin,” since she saw no one else for this.  If a doctor is a dermatologist and the patient sees no one else for skin checks, shouldn’t the dermatologist do a skin check once a year?  I can’t make my sister’s life better, but I can ask this question:  Can there be some guidelines developed by the dermatology association for all dermatologists to check for skin cancer?

Just asking.

Brenda

Dr. Reszko Responds:

Dear Brenda:

I am so sorry to hear about your sister’s diagnosis of skin cancer.  I trust that with appropriate management, whether surgical excision or surgical excision combined with lymph node dissection, a cure rate approaching 100 percent will be possible. Biologically, squamous cell carcinoma tends to be less aggressive than other commonly discussed and often deadly skin cancers—melanomas.  Squamous cell carcinoma is highly curable if detected early and treated adequately.

 Your comment brings up several important discussion points.  

First, skin cancer awareness.  Over the past decades, the incidence of melanoma and non-melanoma skin cancers (basal cell and squamous cell carcinomas) has increased dramatically; these cancers have become a significant focus of public health efforts.  According to current estimates, one in five Americans will develop skin cancer in their lifetime.  More than 3.5 million non-melanoma skin cancers in more than 2 million people are diagnosed in the United States annually. Melanoma is currently the most common form of cancer for young adults 25 to 29 years old and the second most common form of cancer for adolescents and young adults 15 to 29 years old.

 Second, your comment allows for the review of the major risk factors for development of skin cancer.  In addition to genetic makeup, exposure to ultraviolet light is the major risk factor for melanoma and non-melanoma skin cancers.  Recent studies show that simple, daily sunscreen use can cut the risk of melanoma in half.   Exposure to tanning beds and intermittent sun exposure, such as during beach vacations, is particularly dangerous.  People with more than 50 moles, atypical looking moles, light skin, freckles, a history of sunburn(s), or a family history of melanoma and non-melanoma skin cancers are at an increased risk of developing skin cancers.

Furthermore, your question prompts examination of current skin cancer detection guidelines.  The U.S. Preventive Services Task Force (USPSTF) has concluded that there is not enough evidence to recommend for or against routine screening to find skin cancers early.  The USPSTF specifies that doctors should be “aware that fair-skinned men and women aged 65 and older and people with atypical moles or more than 50 moles are at greater risk for melanoma.  Also, doctors should look for skin abnormalities when performing physical examinations for other reasons.”

The American Academy of Dermatology encourages everyone to perform skin self-exams to check for signs of skin cancer and to get a skin exam from a doctor.  Whether specializing in so-called “cosmetic” or medical dermatology, dermatologists—likely more than those in other medical subspecialties—are trained to look for signs of early skin cancer.  A dermatologist should offer a skin exam and make individual recommendations as to the frequency of such exams based on risk factors, including skin type, history of sun exposure, and family history.  Women, such as your sister, with a history of non-melanoma skin cancer are at a higher risk of developing melanoma and other non-melanoma cancers than people without a non-melanoma skin cancer history and should be evaluated regularly.  Individuals with a history of melanoma should have a full-body exam by a dermatologist at least annually and perform regular self-exams for new and changing moles.

So please remember: If you note a spot that is new or changing, bleeding, easily irritated, growing, recurring, or otherwise symptomatic, notify your dermatologist!  You may save a life—yours!

Dr. Reszko