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- Understand Evolving Guidelines. The addition of “E” to the “ABCD's of Melanoma” several years ago underlined the importance of continued education and awareness. David Polsky, MD, PhD, Associate Professor of Dermatology at NYU Langone Medical Center, who was instrumental in incorporating “E” to account for the evolution of moles, says, “The ABCDs are effective guidelines, but the ‘E' captures the importance of various mole features changing over time, encompassing size, color, and shape.” Particularly, he says, it encompasses nodular melanomas, which can start small but grow rapidly.
- Be Thorough and Consistent. “As physicians, we need to do a better job of examining skin in many respects,” notes Dr. Polsky. While identifying clinical features of patients at high risk for skin cancer is essential, i.e. sun-damaged skin, high number of moles, fair complexion, he reminds that all forms of skin cancer, especially melanoma, frequently undermine these patterns and can present in patients lacking these clinical features (e.g. patients with few moles or dark eyes and hair color). “These markers are helpful in terms of how aggressively or not we talk to our patients about the importance of sun protection, but physicians should be thorough and consistent with all patients when performing skin examinations,” Dr. Polsky notes.
- Seek Spousal Support. While doctor visits are a must, creating a climate of awareness means changing behaviors and attitudes outside the clinic. Dr. Polsky notes the value of direct communication with patients about the importance of frequent screening and the harmful effects of UV light. One strategy he recommends to promote self-examinations is to involve loved ones. After performing a skin exam, talk about the importance of routine checks and encourage the involvement of spouses or partners. “Self-examinations are important to discusses, but it can also be helpful to have another person examine your body as well,” says Dr. Polsky. “One of the most common sites for melanoma is the back, and so having a spouse examine your skin from time-to-time can be a very effective strategy to increase awareness and improve the quality of self-examination.”
- Reach Youth. Dr. Polsky suggests that current efforts to educate and increase awareness about skin cancer are inadequate. Given the popularity of natural and indoor tanning, the skin cancer awareness and detection message is important for individuals of all ages. Beyond monitoring those at the highest risk for skin cancer—white men over age 50 or 60—Dr. Polsky advises that it is perhaps most important to spread the message to young people, who are most likely to tan and least likely to consider long-term consequences of prolonged UV exposure. Therefore, it may be wise to remind acne and rosacea patients (often teenagers and young adults) about the health benefits of UV avoidance during their visit. “Increasing awareness among this population may have benefits in the long-term if we can possibly influence habits and behaviors,” he explains.
- Look Ahead. Dr. Polsky notes that the future may bring more effective tests for genetic markers to identify an individual's likelihood of skin cancer. These tests would no doubt help dermatologists learn about melanoma and promote prevention of skin cancer; Dr. Polsky reminds that educational efforts remain integral to enacting widespread awareness. He says that efforts to improve skin cancer awareness will need to combine the continued work of dermatologists in practice, dermatologic organizations, and general practitioners to increase public attention and shift attitudes about UVR.
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