You've Seen The Doctor, But Has He Seen You?
Laura Bush's squamous cell carcinoma of the leg has put skin cancer back on the front page. Skin cancer affects about 1-1.2 million Americans a year. Fortunately, the majority of skin cancers found each year are basal cell (800-900, 000) or squamous cell (200-300,000) - the types that have a very high chance of being cured. About 1-2,000 Americans die each year from these two most common forms of the disease. Death rate has dropped about 30 percent in the past 30 years, perhaps from earlier detection and treatment than in the past.
Melanoma is another story, affecting about 62,000 Americans a year and causing about 8,000 deaths. The vast majority - about 99% - of melanomas occur in patients 20 or older, but even children can occasionally develop this disease. Since I was in medical school in the mid-70's, the number of yearly cases in the United States has more than doubled. Early detection is likely one reason for the increase but nobody is exactly sure what has been causing the dramatic rise. What is clear, however, is that early detection is the name of the game when it comes to curing melanoma. The earlier a lesion is found the better the chance of cure. Which brings us to the main point of this blog.
Everybody should be getting routine head to toe skin exams. This means looking from head to toe at every millimeter of your body, including where the sun doesn't shine. Skin cancers can occur in any location of the body, including the armpits, scalp, between the toes, in the groin or anogenital area - anywhere! Routine self-exam should be part of your screening regimen. If a partner is available who can examine hard to see areas such as the small of the back - all the better.
In addition, I feel that routine screening should include a well-trained health professional who is interested in performing a careful skin exam. This is where it can get tricky. We live in a time when subspecialists abound - even among dermatologists. A patient may see a cosmetic dermatologist several times a year for botox injections. The dermatologist may glance at areas of exposed skin but the patient should not feel that a full screening skin exam is being routinely performed. I've encountered some magical thinking in this area - patients who think that that they've received skin cancer screening just because they've seen a dermatologist, even though they haven't taken their clothes off! Trust me, no doctor is good enough to detect skin cancer without examining the skin.
