PracticalDermatology

Rates of melanoma in the US continue to climb, even as rates of other cancers are on the decline. The American Cancer Society reports that as of 2009, the overall death rate for cancer in the United States had declined 20 percent from its peak in 1991, translating to the avoidance of approximately 1.2 million deaths from cancer. The Society says that incidence rates are declining for cancers at most anatomic sites, except for melanoma of the skin and cancers of the liver, thyroid, and pancreas, which are all increasing among both men and women.

Why, despite dermatologists’ efforts, are skin cancer rates still rising? Perhaps dermatologists are not striking the right notes with their patients. A study of European patients recently revealed that a surprising number of individuals misapplied sunscreen—using it only on nevi. (J Eur Acad Dermatol Venereol. e-pub) Worse still, half of those who engaged in the practice said that a dermatologist told them to do so. While we might like to assume that American patients are better educated than their European counterparts, that may not be the case. Do we know whether our patients are definitely using sunscreens properly...if at all?

American patients admit that they don’t use sunscreens on a consistent basis, even though they say that they understand the benefits of their use. Other patients believe the erroneous assertions that sunscreen ingredients are themselves hazardous to patients’ health.

To make a difference in skin cancer rates requires that dermatologists simplify their message to patients and stop making any assumptions about what patients know—or think they know— about UV avoidance and skin protection. It’s impossible to overstate the obvious when it comes to UV avoidance, and it’s essential to make no assumptions about patients’ UV safety knowledge.

Of course, as I’ve addressed in these pages before, we could make a notable difference in skin cancer survival rates and long-term outcomes if there was increased access to skin cancer screenings— covered by insurance. As the American healthcare system continues to emphasize preventive medicine, preventive skin cancer screenings would allow for more effective detection and management of existing skin cancers. At the same time, it would also provide opportunities for patient education and would potentially send the message to patients that skin cancer avoidance and early detection are actually worthwhile and important undertakings. This could make an impact on behaviors and perhaps even translate to healthier behaviors and lower skin cancer rates.