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In the dermatology world, May is known as Skin Cancer Awareness Month or simply “Melanoma May”. Originally I was hoping to do several things to promote skin cancer awareness, but with all the time required just getting my practice opened this month, I am finally getting around to posting something. Better late than never!
Melanoma is by far the biggest thing that keeps dermatologists up at night. It is estimated that approximately 200,000 people will be diagnosed with melanoma in the U.S. this year and 8,000 will die from this deadly disease. The saddest thing is that most of these deaths could have been prevented with early detection since melanoma diagnosed at an early stage has a 99% survival rate.
I have seen the effects of melanoma not only in my patients, but in my own family as well. I have 3 in-laws who were all diagnosed with melanoma before age 35, and my wife’s grandfather died of metastatic melanoma. Seeing how melanoma has affected patients and families has inspired me to educate patients, friends, and family about the importance of early detection. It has also helped me increase my motivation to constantly improve my skills to accurately diagnose melanoma.
Guidelines for Melanoma Screening
One of the hardest things about melanoma detection is that there are no recommended screening guidelines. The U.S. Preventative Services Task Force is the group responsible for setting the standards for any form of regular cancer screening. Although their recommendations can be controversial and may change from time to time, they have at least published guidelines for breast, colon, prostate, and lung cancers. To date, the USPSTF still classifies skin cancer screening as something for which there is insufficient evidence to recommend a specific time or frequency for screening. This can put dermatologists in a difficult position when patients ask when or if they need a skin cancer screening.
The lack of guidelines means dermatologists are left to provide recommendations based on a combination of research available, clinical experience, expert opinions, and common sense. Each dermatologist has slightly different recommendations based on their interpretation of the information available. Below, I will provide my thoughts for who should see a dermatologist for a skin cancer screening and when this should begin.
When should I start seeing a dermatologist for a skin cancer screening?
I think this might be the toughest question to answer. I believe that with some rare exceptions, children do not need any specific skin cancer screening. When you think about it, we don’t check children for other cancers such as colon or breast cancer. This isn’t because they can’t get these cancers, it is just that such events are so rare that screening is deemed unnecessary. I think the same holds true for skin cancer screening in children which is why I don’t universally recommend it.
If someone has any risk factors discussed below, I think it is reasonable to begin skin cancer screening around age 18. The more risk factors a person has, the earlier they should consider skin cancer screening. Limited studies have suggested a single skin cancer screening done at age 50 is both beneficial and cost effective. Given this fact, I think anyone over 50 should have had a least one skin cancer screening with future planned screenings if they are deemed to be higher risk.
What are the risk factors for skin cancer?
There are many factors that contribute to the risk of skin cancer and the more risk factors a person has, the more important it is for them to see a dermatologist for regular skin cancer screening. The most prominent risk factors include:
Tanning – Even one session of indoor tanning before the age of 35 can increase your risk of melanoma by 75%. If you tanned even more, your risk is much higher. Even if you tanned in the past but have now stopped, you will always be at higher risk and should be screened.
Sunburn – There is hardly a person in this world who hasn’t had a significant sunburn (except maybe the child of a sufficiently paranoid dermatologist). Those with a history of 5 or more sunburns double their risk of melanoma.
Sun Exposure – The more you are outside and exposed to the sun, the higher your risk for skin cancer. Those who work outdoors such as postal workers, builders, or landscapers are particularly at risk.
Moles – Those with 50 or more moles are at much higher risk for melanoma. People with 10 or more atypical moles (meaning moles that have some irregularity to them) have a 12x greater risk for melanoma.
Fair Skin – The lighter your skin is, the higher the risk for melanoma. This is because the pigment that darkens your skin also protects your skin from ultraviolet rays, so those with less pigment have less protection. Red heads or those with many freckles are especially at risk.
Family history of melanoma – Those with a parent or sibling with a history of melanoma have a 50% higher risk for developing melanoma.
Personal history of skin cancer – People with a history of other skin cancers such as a basal cell carcinoma or squamous cell carcinoma have a higher risk for melanoma.
Recommendations Summary
In conclusion, if you are an adult with one or more of the risk factors listed above, I would highly recommend having a skin cancer screening. Those with only one risk factor may not need to begin right at age 18, but those with multiple risk factors probably should start around that time. Just about everyone should have at least one skin cancer screening by the age of 50.
Regardless of whether or not you come in for a skin cancer screening, you should practice good sun protection and should perform a monthly self skin exam where you look at all of your body surfaces to try and detect any irregular moles. If you notice anything concerning, do not delay and see a dermatologist. It may just save your life!
Additional Resources
For more information on melanoma, see the melanoma section of my website at: https://www.mymeridianderm.com/melanoma
Other good resources include:
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