Many significant medical, political, financial, and medico-legal issues face dermatologists, but the issue of skin cancer detection and prevention is clearly among the most prominent. While this year marks the 25th anniversary of the ABCDs of melanoma detection—now known as the ABCDEs (see "Take 5," p. 76)—data indicate that rates of skin cancer continue to rise in the US and around the world. Recent data confirm that skin cancer may be overlooked in patients of color, leading to delayed diagnosis and management and subsequently increased morbidity and mortality for these patients. Meanwhile, the festering vitamin D controversy persists, and tanning seems to be as popular as ever with some teens, young adults, and even some older patients.
Finally, dermatologists are receiving some good news related to tanning and skin cancer, namely, the recent settlement between the Federal Trade Commission and the Indoor Tanning Association (see p. 22) that restricts advertising related to indoor tanning. But the road ahead may be anything but smooth. If the history of cigarette marketing and smoking offers a model, it could be years before the public is truly convinced of the dangers of tanning and meaningfully modifies behavior. Consider that the last advertisement for cigarettes aired on television in 1972, and magazine advertisements have been dwindling over the last decade, yet the American Heart Association estimates that 24.8 million men (23.1 percent) and 21.1 million women (18.3 percent) in the US are smokers.
Dermatologists are lucky that the vast majority of the patients they treat are generally healthy, and the most common dermatologic diagnoses are not associated with significant mortality. That's not meant to discredit the significant morbidity associated with so many dermatologic conditions, but it puts the problem of skin cancer in context: the condition is deadly serious. Dermatologists can never over-do the UV safety message in practice, and they must reach out to patients of every age. Recent strides prove that organized efforts to counteract misinformation and misleading marketing pay off—sometimes quite quickly (it's been less than two years since the AAD brought a complaint about the ITA to the FTC). Now if only the specialty could organize to bring about a final solution to that pesky Sustainable Growth Rate (SGR) and eliminate the annual dread over declining Medicare reimbursement rates!