Skin Cancer Screening

[Andrew Joiner]

My family practice doctors always did skin cancer exams. I've been lucky in 25 years only had two spots removed. It was simple and fast. But this year he suggested a dermatologist because they have a special scope.

In searching for the latest in skin cancer screening I found this article about the pros and cons:

https://jamanetwork.com/journals/jam...%20be%20cancer.


Now I'm wondering how necessary it is for me to get a detailed screening if I don't have any real suspicious spots on my skin.

What do you do for skin cancer screening?

[Doug Garson]

About 7 years ago I went to emergency for an unrelated issue and by luck, the ER doctor who treated me was a Dermatologist. She recognized a basal cell mole on my shoulder and recommended I make an appointment at her clinic to have it removed. I did and since then have been going once a year for a skin check-up. So far I've had three basal cell moles removed. For those who don't know, a basal cell is a slow growing type of skin cancer if left it can be serious, even fatal.

[roger wiegand]

I currently see two different dermatologists (one "regular" and one pigmented lesion cancer specialist at the Dana Farber) on an alternating schedule, seeing one every three months. I'm also participating in a whole body imaging trial for AI based detection of abnormalities. So far they've found five full-blown melanomas and another 8 or so that they graded as "extremely atypical" and another dozen or so that only made it to "atypical". I've only had 2-3 excisions that came back as normal. Fortunately all but the very first one was detected very early and treated simply.

My rule is unequivocal-- when in doubt, cut it out. I wish that I had been being screened routinely to catch the first one much earlier 20 some years ago. I'd regard a skin check by an expert to be an essential part of normal health care, like checking your blood pressure and blood glucose. You really don't want to let that first one get away on you. Your dermatologist will recommend a schedule based on your history, sun exposure, age, etc. It might be annual, but might be every 2-3 years. For those of us who work in shops and have cuts and scrapes on a very regular basis the added "risk" of what turns out to be an unnecessary biopsy or two are pretty minimal.

[Mark Rainey]

Andrew, you provide a good link. I hope everyone reads it. Cancer scares us. Fear can lead us to do good things, but also foolish things. We just do not know if routine screening for skin cancer is a good thing or a foolish thing. It is hard for us to understand this. Fortunately basal cell cancer is rarely fatal. Read the link Andrew provided. If contains wisdom. And sometimes the best wisdom says "we just don't know".

[Ken Fitzgerald]

Male pattern baldness is rapidly catching up to me. I have alternated between doing a comb-over and just cutting my hair short all over. Last spring I had it cut short all over and a few days later, I had a semiannual physical. My primary care physician noticed an odd colored mole on top of my head for the first time and referred me to a cancer clinic. There they performed a shave biopsy. Now, I will have annual checks by a skin cancer specialist. Do your research and talk with your health care providers. Make your decision based on your opinion and the opinion of the experts.

[Jim Becker]

Getting a screening by a professional that specializes in them is not a terrible thing, even if your PCP does "routine" screening as part of their normal wellness practices. It sets a baseline and that kind of screen is a lot more comprehensive in order to catch the "little signs" that might escape more cursory exams. I'm actually due for another one as it's been a few years now.

[Doug Garson]

The JAMA article overlooks one important thing, family history. According to the Skin Cancer Foundation. "Each person with a first-degree relative diagnosed with melanoma has a whopping 50 percent greater chance of developing the disease than people who do not have a family history of the disease."

https://www.skincancer.org/blog/what...the%20disease.

[Jack Frederick]

I do my annual trek tot the Dermatologist. He can always find something to burn/freeze off. Melanoma and Pancreatic cancer are fellow travelers and my Dad passed from PC. I see him annually and so far so good.

[Warren Lake]

got way too much sun as a kid. had a spot forehead. Asked family doctor and he said it was nothing. I said get a specialist. Specialist said its nothing. I said take it off. Turned out It was a skin cancer. he cut it off.

year later it was coming back again. I was loading a trailer of supplies to go to africa and a lady there worked for a top skin doctor. She looked and said he didnt get it all so its growing back WTF. Two doctors tell me it was nothing, not a very good reflection on their craft.

I ended up trying weed oil on it and it shrunk and has never come back.

[Sam Force]

I see a dermatologist at least once a year, have had at least a dozen pre cancer spots removed and 2 squamous cell cancer spots removed. I think a lot has to do with getting older and the sun exposure is showing up now.

[Mark Rainey]

So we have the medicalization of aging. Sad but true. Go to your doctor and have him check every inch of your body out of fear because medical science says it is not rational. Unnecessary medical procedures abound. Medical costs increase. Medical insurance skyrockets. And in the end there is no evidence that says skin screening prolongs life. The system is broken.

[Erik Loza]

I spent too much time in the sun during my 20’s and have fair skin that freckles easily. My dermatologist would slice off something pretty much every annual exam. Biopsies were always negative but then, about five years ago, I got a call saying they found something. Turned out to be a malignant melanoma. They were like, “We need to schedule your procedure ASAP”, which I took to mean it was potentially quite serious. Anyhow, I go in for mole patrol twice a year now and probably will for the rest of my life. Skin cancer just seems so easily detectable, like colon or breast.

Erik

[Stan Calow]

an exam by a skin professional is worth it. They can see spots and potential problems long before they are visible to you, especially on places like your ears, back and shoulders. Your GP may not see them or recognize them like a specialist would.

I went in with a suspicious spot that turned out to be harmless, but in the complete exam, other places were found.

[Mark Rainey]

If I look hard enough I will find cancer cells in your body. The more I biopsy the more I find. But you will not live longer. Look at Andrew's link. We just do not know.

Our data are consistent with the possibility that public health efforts directed towards early detection of melanoma may contribute to melanoma overdiagnosis, particularly with regards to in situ disease. However, it is also possible that increased biopsies are driven, in part, by underlying increases in melanoma incidence rates. Additional research is needed to further clarify the relationship between melanoma screening, incidence, and mortality. Meanwhile, the relationship between increasing biopsy rates and increasing melanoma incidence rates must be interpreted cautiously. It is notable that the incidence rate of invasive melanoma did not continue to increase between 2005 and 2009, while the rate of skin biopsies did continue to increase, suggesting that the relationship between biopsy rates and melanoma rates is not fully understood. Over-diagnosis of other cancers such as breast, prostate and thyroid cancers has been reported, with efforts underway to reduce unnecessary cancer-related screening, surveillance, and other medical interventions (3). Similarly, we believe that continued collaborative efforts are needed to further advance the dermatologic community toward optimized care delivery for all patients at risk for melanoma.

[roger wiegand]

I'm surprised that the data for early removal of potentially deadly tumors isn't more compelling. Surprised to the point where that little bell in the back of my head that saw me through a long and fairly successful career as an experimental biologist is ringing loudly, suggesting that there is something wrong with the data/experiment. Unfortunately the cost and size of the clinical trial required to properly answer the question means it's not going to happen.

I guess the argument is that for many people they will die of something else before the melanoma kills them, and therefore shouldn't bother looking for it. I don't, personally, find that argument particularly comforting. There is an argument to be made for "watchful waiting", which is how most prostate cancer is managed in the US. In most people that cancer is very slow moving and, indeed, most people outlive it. But I'd put the emphasis on "watchful"-- know it's there and pay attention to how fast it's growing to make individual treatment decisions. Intervention for prostate cancer can carry a pretty high cost in terms of effect on the patient, so such an approach is well justified.

In the case of melanoma one might make the same argument, but the cost of intervention is very low-- basically doing the diagnostic test, a shave biopsy, effectively treats the cancer when done early enough. Allowing tumors to progress to the point where much more invasive interventions like lymph node removals, chemo, and radiation are needed for treatment, even if just in a few percent of patients, seems really hard to justify.

It may well be the case that from an economic point of view we'd do better if the standard treatment were to simply excise suspicious spots without doing any pathology exam unless they recur, as that early excision is successful in a large majority of cases. But not looking at all? I'm not buying it without much more compelling data.