After much anticipation and speculation, new sunscreen guidelines go into effect next month. Although further refinements are expected, the new labels represent a significant step for an industry that has grown and advanced tremendously in the last few decades. Feature articles in this issue (p. 27 and p. 31), address both the label revisions and new sunscreen technologies.
The new verbiage on sunscreen labels is intended to ensure clarity and consistency from one brand to another and to help patients more effectively assess any product for use. However, new labels will undoubtedly be a source of confusion for some patients—both for those who have been faithful sunscreen consumers and users and for those who have been resistant to the sun protection message. The uninformed might assume that introduction of new terms signifies that products didn't actually provide protection as promised.
More than ever, dermatologists must be prepared to discuss sun protection with patients and answer their questions about how products work and which to choose. Ultimately, patients must identify a product they like enough to use every day and that they can afford. Products can be costly, and patients who use the proper amount of sunscreen every time will find that they empty bottles often.
Sun protection is a key strategy in skin cancer prevention. But for many Americans, a history of virtually unmitigated sun exposure means a high risk for developing melanoma or non-melanoma skin cancers. Therefore, regular skin exams are critical for early detection and treatment of cutaneous malignancies.
Within just a few years of clinical practice, every dermatologist finds a skin cancer that would have gone unnoticed or perhaps had already been misdiagnosed as benign. And with continued practice, those instances accumulate. Now research supports what personal experience has shown: skin exams save lives (J Am Acad Dermatol. 66(2):201-11).
Read more about the study in the March “Oncology Watch” available at PracticalDermatology.com.
Yet, only AAD, NIH Consensus Conference on Early Melanoma, and the American Cancer Society currently recommend regular skin cancer screenings in the general population, and few payors cover screenings. Medicare currently does not cover general skin cancer screenings.
this era of healthcare cost containment, where preventive medicine is touted as fundamental to reducing the financial burden of patient care, the reluctance to cover skin exams is baffling. Preventive medicine is so popular because evidence shows that it is generally more expensive to address a pathology than to stop it in the first place. And if a disease cannot be entirely prevented, treatment in its earliest stages is typically more effective and less costly compared to the treatment of advanced disease.
When skin cancers are detected at early stages, simple excisions or destructive modalities are very often curative and relatively inexpensive. Therapeutic costs rise significantly as disease progresses. Plus, there is the toll of morbidity and the increased risk for complications and adverse events associated with more advanced treatment strategies.
The cost of a general skin exam is the cost of a standard office visit. Payors ought to reconsider coverage of these exams; a nominal expense for the visit could save a good deal of money over the long-term. Most importantly, it can save lives.