A three-person panel advising the National Cancer Institute (NCI) recently made a recommendation that is irresponsible, short-sighted, and indefensible. So indefensible, in fact, that one need only look to the NCI’s own definition of cancer to recognize the folly of the panel’s preposterous assertion.
Nonetheless, the team’s views, published in Lancet Oncology, are now published and widely reported, and dermatologists are now tasked with the challenge of assuring patients, other medical professionals, public health officials, and third party payers that skin cancer is cancer.
That squamous cell carcinoma, basal cell carcinoma, and melanoma are cancers is a medical fact. By the NCI’s own definition, “Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues.”
But the panel seeks to define “cancer” by its likelihood of causing death, suggesting that the classification be reserved only for aggressive or high-mortality tumors, while less aggressive or rarely fatal cancers can be called “indolent lesions of epithelial origin” or IDLE.
The problem is that cancer is defined by its pathogenesis, not its outcome. Skin cancers invade, metastasize, and kill. Skin cancers disfigure, debilitate, and kill. Skin cancers, left untreated, kill.
In a statement to The Wall Street Journal, NCI panelist Laura Esserman, MD, MBA, said, “People have to get over the concept that early detection saves lives.”
This statement flies in the face of the available evidence in skin cancer research, the positions of the AAD, ASDS, and Skin Cancer Foundation, and the collective experience of thousands of dermatologists.
Skin cancers can be diagnosed fairly inexpensively, and when they are detected early and treated efficiently, management is relatively inexpensive.
The panelists behind the IDLE terminology are urging less aggressive approaches to management of IDLE conditions, such as skin cancer. After all, doing nothing costs... well, nothing. Except perhaps a couple hundred lives per year.
Hopefully, insurance carriers will not be swayed by this ridiculous argument. They could easily be attracted by the logic and thereby refuse to cover skin cancer treatment. Meanwhile, we as a specialty have to stand up for science— and for our patients. We can’t be idle. We have to get the word out: Skin cancer is cancer, and it kills.
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