Pharmacists Must Alert Patients: Self Examination for Skin Cancer Doesn’t Yield Early Detection
Now that summer is over, it’s a good time to revisit the topic of sun protection, urge patients to reflect on their sunscreen use—or lack of diligent use—talk about melanoma, and help clarify for them the recent news that skin self-examination fails to detect early cancer.
This information could be discouraging, considering the constant push to encourage skin self-examinations, so don’t leave patients hanging with nothing but bad news. Pharmacists should play a supportive role, and must be sure to convey to patients that melanoma is curable with early detection. It is very important that patients understand that self-exams are still highly useful if done correctly and efficiently, and can continue to be a life-saving process.
Impact of Self-Examination for Skin Cancer
For years, patients have been told to examine their skin for signs of cancer. Studies have touted how self-examination results in early detection of melanoma and fewer deaths. In fact, one study published in BMC Dermatology in March 2013 reported that people who perform skin self-exam (SSE) have 50 percent less advanced melanoma and significantly lower melanoma-related mortality.1 Yet deaths from melanoma remained stable from 2004 to 2013.2 And if that’s not confusing enough, a new study just solidly overturned the 2013 report and seems to negate the purpose of SSE.
The retrospective study, published in the Journal of the American Academy of Dermatology in September 2016, was based on data from 783 patients diagnosed with cutaneous melanoma between 1996 and 2012.3
After reviewing the patient’s records, the researchers found that:
- Melanomas were self-detected in 53 percent of patients.
- Melanomas were found by a dermatologist in 20 percent of cases.
- The remaining cases were detected by friends, family, non-dermatologist physicians, or health care workers.
- Self-detected melanomas were significantly thicker and more frequently ulcerated.
- Self-detected melanomas had a higher incidence of metastases and were associated with more deaths.
- Among patients with self-detected melanomas, one-third only went to the doctor due to bleeding, itching, pain or when the nodule got larger.
Instead of early detection, this study says that self-exams don’t find cancer until the disease is more advanced and the prognosis is poorer. Now the message is this: SEE helps some patients, but they get better results with a routine skin exam from a trained physician. This type of information is guaranteed to make patients collectively shrug and wonder why they should bother with SEE at all. While it’s essential for pharmacists to lay out the facts, you also need to go a step further to educate patients about how they can make SEE successful.
Factors That Facilitate Successful Skin Self-Exam
Information from this study can be conveyed with an attitude that reflects “just go see your doctor,” or it can be used to motivate patients if it’s communicated from the perspective of “skin self-exam can be beneficial and this study highlights the importance of doing it the right way.” It’s important to reinforce the message that early detection facilitates cancer-curing treatment, and to then use these tools to help them learn about performing the most effective skin self-exams possible:
- Bolster confidence – They may feel as though they are unsure what to look for and consequently do not conduct exams regularly. Pharmacists can educate patients on all aspects of the exam to help them feel more confident doing it themselves.
- Encourage diligence – Ask patients how often they do a skin exam. Is it possible that more time passes between exams than they realize? The Skin Cancer Foundation recommends a head-to-toe exam every month, so suggest they do it on the first day of each month. They should put a note on the calendar to show they did the exam and to record anything out of the ordinary.
- Get a Partner Involved – When patients team up with a spouse, family member or friend, and they’re trained to find melanomas, they find more suspicious moles and substantially more early-stage melanomas.4 Be sure to print out information on how to perform a skin exam so patients have a routine guide to follow.5
- Use Image – One of the biggest roadblocks with self-detection of melanoma is that patients have a hard time recalling skin appearance and what makes a mole dangerous. It’s easy to say that a change in the size, color or shape of a mole are all warning signs—it’s another thing to actually identify subtle changes. Having images at hand improves the accuracy of SSE and even motivates them to perform the exam. The American Academy of Dermatology and the Skin Cancer Foundation offer free online resources like images and printable charts to map moles on their body. Remind them that they’ll get better at recognizing changes when they get into the habit of doing monthly exams.
You can also encourage and relieve patients by talking about topical treatments that cure precancerous lesions on the skin like actinic keratosis. Tell them that SSE really does pay off when they find problematic moles in time enough to use products like topical diclofenac sodium 3 percent gel, ingenol mebutate, 5-fluorouracil and imiquimod.
Pharmacists Encourage Compliance and Success
When asked why they don’t do skin self-exams, the most common reasons patients give are that they forgot, they didn’t know what to look for, or didn’t know they should even check over their skin.6 When pharmacists take time to educate patients, whether through personal counseling or a special display with skin cancer information on an endcap, you get them started on the right path. But if they haven’t talked to a doctor, encourage them to schedule an appointment to get a baseline exam and discuss any concerns. The bottom line is that melanoma is curable with early detection, so encourage patients to find a way to make that happen.
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- “Barriers and Facilitators of Adherence to Medical Advice on Skin Self-Examination During Melanoma Follow-up Care,” March 2013, http://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-13-3 ↩
- “SEER Stat Fact Sheets: Melanoma of the Skin,” 2016, http://seer.cancer.gov/statfacts/html/melan.html ↩
- “Who Detects Melanoma? Impact of Detection Patterns on Characteristics and Prognosis of Patients with Melanoma,” September 2016, http://www.jaad.org/article/S0190-9622(16)30486-8/abstract ↩
- “Partner-Aided Skin Exams Increase Early Detection of New Melanomas,” July 2016, https://www.cancer.gov/news-events/cancer-currents-blog/2016/partner-skin-exams-melanoma ↩
- “Step By Step Self Examination,” 2015, http://www.skincancer.org/skin-cancer-information/early-detection/step-by-step-self-examination ↩
- “Study Finds Some Don’t Know How to Spot Signs of Trouble,” October 2015, https://healthfinder.gov/News/Article.aspx?id=703969 ↩