DermHelpCentral

Skin Cancer Screening: 2016 Recommendations

Image from Times article

Should you get screened for skin cancer?
By Nicholas St. Fleur
New York Times, July 26, 2016

In July 2016, the U. S. Prevention Services Force stated that there is no good evidence for the efficacy of skin cancer screening to prevent death or significant disability. This means that the benefits do not outweigh the potential harm of skin cancer screening.

Nonmelanoma skin cancer comprises 98% of skin cancer's and account for only about .1% of all cancer deaths. Melanoma accounts for about 10,000 cancer deaths a year.

If you have a personal or family history of melanoma, and if you have more than 100 moles you should probably consider being screened. But if not, you could safely pass. A large study in Germany found that skin cancer screening can potentially save one life per hundred thousand individuals screened. It is likely that much more harm could be done from over diagnosis and over treatment in a large screen and population.

Screening picks up small very slow growing or not even growing melanomas that are not destined to harm a patient. However, once they are discovered usually aggressive therapy is recommended and the patient is then labeled as a cancer survivor.

Most dermatologists recommend skin screening. In spite of the lack of evidence for its efficacy, it's good business practice for skin doctors. A skillful dermatologist can find something to treat with cryotherapy or a biopsy on most older caucasians, and this provides a good living for these doctors. It's a low risk screening and a high-value return for dermatologists.

The smart patient should avoid skin cancer screenings if they are not at risk. They should specifically avoid the free skin cancer screenings offered by many hospitals and aggressively promoted by the American Academy of Dermatology. They can just say no. If they have risk factors for skin cancer or are worried about specific lesions they can request a complete skin examination. This may be a good way of alleviating anxiety related to specific skin lesions.

The article in July 26, 2016 New York Times is a good overview. It can be accessed at: http://nyti.ms/2albmU/

Treatment Options for Basal Cell Carcinoma

Three common treatments for basal cell carcinoma (BCC) are shown and described in this video, with pros and cons discussed.  These include excisional surgery, electrodessicaton and curettage and topical imiquimod.

Mohs Micrographic surgery and radiotherapy are not covered. 

This video does cover the most pertinent options for most patients and is a valuable educational resource.

Tanning "Parlor" Wars

F.D.A. Proposes Ban on Indoor Tanning for Minors to Fight Skin Cancer (This article appeared in the December 19^th 2015, NY Times)

“The Food and Drug Administration on Friday proposed barring everyone under 18 from using tanning beds, a sweeping move that medical experts say is a major step toward reducing the risk of skin cancer in the United States.”

The incidence of melanoma has been steadily rising over the past two decades. Importantly, as this article states, “death rates [from melanoma] have not gone up, however, a testament to earlier detection and better treatment.” This may not be a result of early detection and treatment, but because pathologists are calling lesions melanoma that would not have been labeled as such in the past (diagnostic drift) or because melanomas that are stimulated by artificial UVL behave less aggressively than melanomas that are caused in other ways.

Demonizing “tanning parlors” may well be attacking a soft target. Still, we agree that regulating the use of artificial tanning facilities, especially for minors (who appear at increased risk) is prudent. Thinking that this is based on good science, may be off the mark.

Basal Cell Radiotherapy

Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: our experience in 671 lesions.

Caccialanza M et.al Eur Acad Dermatol Venereol. 2009 Sep;23(9):1044-9

J Eur Acad Dermatol Venereol. 2009 Sep;23(9):1044-9.

Abstract

BACKGROUND: The skin overlying the nose cartilage is a particularly frequent localization of skin carcinoma (about 25% of all carcinomas occurring on the head and neck). It is therefore of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result.

OBJECTIVE: To verify both the therapeutic effectiveness of dermatologic radiotherapy and its 'toxicity' in the treatment of a large number of skin carcinomas overlying the cartilage of the nose.

METHODS: A retrospective study was done on 671 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2007.

RESULTS: The mean follow-up time was 38.016 months (range, 1-351 months). The 5-year cure rate was 88.09%. Cosmetic results were evaluated as 'good' or 'acceptable' in 96.84% of the treated lesions in complete remission. So far, no complication or sequelae to the radiologic treatment have been observed.

CONCLUSION: Dermatologic radiotherapy showed to be a safe, effective and non-invasive method, superior, on the basis of the literature data, to any other available therapeutic modality in the management of basal and squamous cell skin carcinomas localized over the nasal cartilages.

Comment: I think Moh's surgeons would say that their cure rates are higher, but then, this group may include very complex lesions that were not amenable to Moh's or that would have left significant defects.  One would need to review this article carefully. DJE