Physician Spotlight: Anna L. Chien, MD

Tremendous progress has been made in diagnosing and preventing skin cancers, but more is needed to end this epidemic. Anna L. Chien, MD, an associate professor of dermatology at The John Hopkins School of Medicine in Baltimore and part of the Skin Cancer Foundation’s Photobiology Committee, provides her take on what’s left to do to win this war and why it matters.

What have some of the recent advances been in terms of diagnosing and treating skin cancers?

Anna L. Chien, MD: Recently, we’ve seen an influx of mole tracking and skin cancer detection apps. The Skin Cancer Foundation has always recommended that adults perform a skin self-exam at least once a month, since skin cancers caught early are almost always curable. This is where apps can help. During a monthly self-exam, patients can compare photos from the previous months and take note of any changes. Of course, it’s extremely important to remember that these apps are not diagnostic tools. They do not, and should not, diagnose skin cancers—only a visit to a dermatologist’s office and possible skin biopsy can provide a diagnosis. In fact, studies are ongoing to determine whether similar technology can also be used by the dermatologist to track nevi, for instance. There is also research evaluating whether a concerning skin lesion can be assessed using less invasive techniques that spare the patient a skin biopsy. As technology continues to evolve, I suspect we’ll see many more new and improved techniques to enhance skin cancer management.

Are you concerned that widespread shutdowns delayed skin cancer diagnoses?

Dr. Chien: Since the pandemic is still ongoing, we can only speculate on the effects it will have on skin cancer rates and the stage at which cancers are found. According to one study, new skin cancer diagnoses were down about 80 percent in March 2020 from early February 2020. With dermatology practices and clinics around the country forced to shut down for months, many people may have missed or postponed scheduled skin cancer screenings during this time. As offices have mostly reopened, doctors are now facing a backlog of patients and we also know that many people, including those that are at high-risk of COVID-19, are worried about leaving their house to go to the doctor’s office. However, we won’t really be able to know these exact numbers and effects until the pandemic is under control. We may only see these effects years down the road. It’s possible an initial spike in skin cancer rates could be attributed to the fact that many have gone undetected during lockdown. Of course, skin cancers can be successfully treated if caught early. This is why annual skin exams with a board-certified dermatologist are so important. If patients aren’t having their skin examined, a skin cancer could go unnoticed and have the chance to metastasize to other areas of the body leading to potential disfigurement or even death. If an in-person professional exam isn’t an option for certain patients right now, teledermatology may be an option. While a full, comprehensive skin exam is not possible with telemedicine, a dermatologist can assess any potentially harmful lesions virtually and advise a patient if they need to come in or not.

Have we made inroads in encouraging people to use sunscreen and engage in sun-safe behaviors?

Dr. Chien: I believe we’ve made great progress in some aspects of curbing risky behaviors and encouraging sun protection. Using indoor tanning devices, for example, is a significant risk factor for skin cancer. People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent. We are seeing indoor tanning behaviors decline in the US. One study found that indoor tanning among US high school students decreased by 53 percent between 2009 and 2015. Eighteen states plus the District of Columbia have banned indoor tanning for minors completely. There’s still work to be done, but we’ve made encouraging steps in the right direction.

I also think people are much more aware of the sun’s dangers than they were decades ago. Consumers are realizing that everyone needs sunscreen regardless of race or ethnicity. More patients are recognizing that sun protection should be a daily habit. The message is getting through that sunscreen isn’t just meant for a day at the beach; you need to wear it every day and cover up with clothing, hats, and sunglasses. People are also recognizing that sun avoidancewill protect you from photoaging, so consumers are turning to sunscreen to ward off fine lines, wrinkles, and hyperpigmentation.

Can we do better at encouraging sun safe behaviors?

Dr. Chien: As dermatologists, it is critical we maintain these efforts as there remains gaps in photoprotection knowledge. For instance, there is data that shows that patients with skin cancer still suffer from more sunburns compared to individuals without skin cancer and that they may not be taking advantage of all the photoprotection methods available to them. We also know there are patients who are more vulnerable to the damaging effects of solar irradiation, may it be patients on certain photosensitizing medications or patients with depression. Thus, every visit with a patient is another opportunity to review and support sun protection measures.

What is needed to end the skin cancer epidemic?

Dr. Chien: While more people are recognizing the dangers of unprotected UV exposure and the importance of sun protection, we still have to translate this awareness into changes in behavior. It’s not enough to acknowledge the benefits of everyday sunscreen use, you have to actually commit to applying it. By making sun protection a part of your daily routine, it can become second nature, and these good habits can be passed down to the next generation.

Early detection is also key. The public may be more aware of skin cancer risk factors than they were years ago, but it’s crucial to perform self-exams and visit a dermatologist regularly for a professional exam. We need to drive home the idea that if you see anything new, changing or unusual on your skin, it’s time to make an appointment with your physician.