Physician Spotlight: Maral Kibarian Skelsey, MD

Many people skipped their annual skin cancer checks during the early days of the COVID-19 pandemic due to lockdowns and shelter-in-place orders, and dermatologists like Maral Kibarian Skelsey, MD, Director of the Dermatologic Surgery Center of Washington in Chevy Chase, MD, and spokesperson for The Skin Cancer Foundation, are now seeing the devastating effect this had on skin cancer diagnoses. Here, Dr. Skelsey discusses what she is seeing in the clinic and also highlights some of the progress made in treating skin cancers in recent years.

How did COVID-19 affect skin cancer rates?

Maral Kibaria Skelsey, MD: It’s difficult to draw concrete conclusions about COVID-19’s effect on skin cancer rates while the virus is still active. Anecdotally, we know that many people were unable to visit dermatologists during the darkest days of the pandemic for many reasons: some people couldn’t get medical appointments because offices were closed, others wanted to avoid in-person contact, and some nursing homes and assisted living facilities recommended residents postpone any non-essential appointments. We all know we can treat skin cancers successfully when we catch them early, which is why skin exams are so important. In fact, The Skin Cancer Foundation (SCF) recommends adults see a dermatologist at least once a year for a skin exam. We also know that when people are unable to make appointments or are forced to cancel or reschedule them, the clock starts to tick. Many patients have turned to telemedicine for their preventative care appointments, including skin exams. One of my patients with advanced melanoma had actually been seen by his internist on telemedicine, but his lesion was not visible on the screen. While this is better than nothing, a telemedicine visit cannot replace an in-person exam by a dermatologist. It can be difficult to see subtleties in moles or lesions through a camera, and dermatologists use touch and texture to evaluate the skin, as well.

What are some of the consequences?

Dr. Skelsey: Personally, I have seen patients presenting with larger, more advanced skin cancers following the pandemic. I’m getting a lot of new patients coming in because they’re concerned about lesions on their skin, but also returning patients who haven’t been in for an appointment in three or more years. In my own practice, I have encountered some of the largest and most advanced cases of my career. These patients unfortunately presented with cancers that have already metastasized—which underlines the acute need for timely screening in order to detect these skin cancers before they spread. Luckily, now that we have immunotherapy, these patients are responding to treatment and doing well.

I think skin cancers that would usually have been caught earlier escaped detection during the worst of the pandemic. People may have relied on telemedicine appointments with primary care physicians who are not specially trained to recognize skin cancers. They may have been living in isolation, whereas normally a friend or relative would have pointed out a suspicious mole. It’s imperative we communicate to patients that regular self-exams can help them identify suspicious spots and that if they see anything new, changing, or unusual on their skin they should see a dermatologist as soon as possible.

COVID-19 aside, what are some of the biggest challenges in skin cancer today?

Dr. Skelsey: Early detection, in general, is a challenge. It’s so important to remind people to regularly examine their skin for anything new, changing, or unusual. The ongoing challenge of getting skin cancers diagnosed and treated early is one reason I value The SCF’s mission and have volunteered for their mobile skin cancer screening program, Destination Healthy Skin. Many people who get screened at these events have never had a skin cancer screening before and may never have gotten one if it weren’t for the program coming to their city.

Any movement on FDA’s Sunscreen Innovation Act?

Dr. Skelsey: Not that I’m aware of. I’m anxious to see what will happen next. The Skin Cancer Foundation encourages further research on the 12 sunscreen ingredients that have not yet been deemed generally recognized as safe and effective (GRASE), in hopes that additional data can help FDA come to a conclusion about the safety of these UV filters. We also hope FDA will take action in approving new sunscreen ingredients that could help diversify consumer choices.

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Are skin cancer prevention messages (finally) setting in?

Dr. Skelsey: I think we’ve made some great progress spreading the word about skin cancer prevention tactics. More people are aware of the dangers of ultraviolet (UV) rays from the sun and are taking steps to protect themselves. Fewer people are indoor tanning today than they were 10 or 15 years ago. One study found that indoor tanning among US high school students decreased by 53 percent between 2009 and 2015. Of course, we still have work to do. In the past decade (2012 – 2022), the number of new invasive melanoma cases diagnosed annually increased by 31 percent. We must continue to have conversations with older patients who may have gotten a lot of sun exposure over the decades, and make sure they understand that since sun damage is cumulative; they still have to protect themselves. Early detection is key in this situation as well. If previous damage has led to a skin cancer, we want to remove it as quickly as possible to achieve the best possible prognosis.

What are some of the greatest advances we have made in the treatment and prevention of all skin cancers?

Dr. Skelsey: I think the breadth of sun protection products on shelves today is impressive compared to the options available several years ago. People can choose between so many different formulations of sunscreens with different ingredients. There’s something out there for everyone, so there’s no excuse not to protect yourself. On the treatment front, the last several years have produced incredibly exciting advances in the field of immunotherapy. In 2018, the immune-oncology drug cemiplimab was approved by the FDA for the treatment of patients with metastatic cutaneous squamous cell carcinoma (SCC) and for patients with advanced local SCC who are not suitable candidates for surgery or radiation. In 2017, the FDA approved avelumab for the treatment of some patients with Merkel cell carcinoma. These drugs are changing the game when it comes to treating advanced skin cancers, and we will surely see more advancements in immunotherapy.