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“We are doing really well,” says Desiree Ratner, MD, Director of the Comprehensive Skin Cancer Program at Mount Sinai Downtown in New York City. “If skin cancer is caught early, it’s curable, and we are catching more skin cancers early.”
Here’s where we stand today:
Skin Cancer Prevention
Wins: California, Delaware, District of Columbia, Hawaii, Illinois, Kansas, Louisiana, Massachusetts, Minnesota, Nevada, New Hampshire, North Carolina, Oregon, Texas, Vermont and Washington ban the use of tanning beds for all minors under 18. At least 42 states and the District of Columbia regulate the use of tanning facilities by minors, and some counties and cities do the same, according to the National Conference of State Legislatures.
Opportunity: Exposure to the sun’s ultraviolet rays or artificial rays in tanning beds is a major cause of skin cancer, and not tanning could prevent more than 5 million cases of skin cancer every year, according to the American Melanoma Foundation. “There is more work to be done in education on the dangers of tanning beds and tanning in general, especially among teens,” says Andrew F. Alexis, MD, MPH, Chair of the Department of Dermatology at Mount Sinai St. Luke’s and Mount Sinai West in New York City. He is also Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai.
Win: In March 2018, the US Preventive Service Task Force (USPSTF)called for behavioral counseling to prevent skin cancer for individuals aged six months to 24 years with a fair skin type, including parents of young children.
Opportunity: Some say these guidelines don’t go far enough.They American Academy of Dermatology Association points out that skin cancer prevention is important for people of all ages and skin types, not just those with fair skin between the ages of 6 months and 24 years. And a recent study showing that 70 percent of Americans who’ve used tanning beds have never had a skin check by a doctor suggests that counseling efforts need to be amplified. These researchers also found that people who frequent tanning salons are more likely to use a sunblocks with lower SPFs, further raising their risk for skin cancer.
Wins: All but gone are the deep tanning oils and reflectors that were so commonplace at pools and beaches in the 70s and 80s. Today, it’s about broad-spectrum sunscreens, wide-brimmed hats and rash guards.
Opportunity. Not everyone is heeding the call. “There’s a serious misconception out there that darker-skinned individuals are immune to skin cancer, and that’s just not true,” Dr. Alexis says. These individuals are less apt to use sunscreen and engage in other protective measures. Darker skin produces more of the pigment called melanin that does help protect skin, but it’s not a magic shield. “The risk does vary according to skin pigmentation, genetics and sun protective behaviors, but anyone can potentially develop skin cancer,” he says. “It’s remarkable how much of an impact we have made, but we need to continue to get the word out especially among young people and those with skin of color and really find new ways to drive action in these populations.”
Win: The American Society for Dermatologic Surgery Association’s (ASDSA) SUNucate model bill would allow students and campers to possess and use sunscreen while on school or camp property or at an event or activity sponsored by the school or camp — without a doctor’s note or prescription. Maryland is the ninth state to pass SUNucate legislation allowing children to possess and use sunscreen at school. “The passing of this bill helps encourage children to develop sun-safe behaviors early on, like sunscreen application,” says ASDSA President Lisa Donofrio, MD, in a news release. “Maryland’s efforts reinforce the importance of teaching children the risks of sun exposure during outdoor activities and how to best avoid skin cancer.”
Opportunities: There are 41 other states who have yet to get on the SUNucate bandwagon.
Win: Technology is changing the way we do everything including how we spot skin cancer. There are many apps that may help determine whether a mole is potentially cancerous and requires an evaluation by a doctor. In fact, the story of a UK woman who found a skin cancer using an app called SkinVision went viral. And a widely publicized study in Nature showed that acomputer can identify images of skin cancer and lesions as accurately as a dermatologist.
Opportunities: Apps will likely never replace a visit to the dermatologist, but if they can get people in the door earlier than they would have otherwise, that’s a good thing.Early detection and treatment are key, which is why it’s vital to pay attention to every mole and mark on your skin. It is also critical to see a dermatologist once a year for full body exam because melanomas often tend to hide in less obvious place, like between your toes, your scalp, back, the soles of your feet, and your back, just to name a few. You need to be on the lookout for precancers called ‘actinic keratoses’ or ‘AKs’ for short, and suspicious looking moles called ‘dysplastic nevi’ that can be risky too.
Wins: There are three main types of skin cancer: Basal cell carcinoma, squamous cell carcinoma, and melanoma, the potentially fatal from of the disease. Our ability to treat all skin cancers has improved greatly over the past decade, he says. “As far as surgical techniques go, today’s surgeries leave less of a scar and look better cosmetically than they did a decade ago,” Dr. Alexis says.
Another modality, Superficial Radiation Therapy using Sensus’ SRT-100™, is proving to be a game changer for individuals with non-melanoma skin cancers who are not candidates for or do not want to undergo surgery. SRT treats lesions with indirect radiation that does not penetrate and affect underlying healthy tissue. Dermatologist David J. Goldberg, MD, JD, adds that for some skin cancer patients who may not be the best candidates for Mohs surgery, SRT is an ideal treatment. These include the elderly, surgery phobic, cosmetically concerned, as well as those who are poor surgical candidates. Superficial radiation therapy, with its high cure rates, has given me an excellent solution. The use of SRT in my practice is the right non-surgical approach for these patients. In addition, the use of SRT for keloid scars has added a new dimension to my cosmetic practice and offers a highly successful treatment approach for this disabling condition. ”
There are new drugs that treat aggressive melanoma, and two new oral drugs that shrink basal cell skin cancers that are spreading or too big to treat with surgery, Dr. Ratner says. These include are Erivedge (vismodegib) and Odomzo (Sonidegib).What’s more, certain melanoma drugs called programmed cell death protein 1 (PD-1) inhibitors may have a role in treating spreading or advanced squamous cell carcinoma.
Opportunities: It’s great to have all of these therapies to treat skin cancer, but the ultimate goal is to never get it in the first place, and this is where enhanced prevention messages come in.