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For the general population the USPSTF (United States Preventative Services Task Force) concludes that ‘the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.’
This leaves one, at any age, to consider and understand their own risk and use common sense to determine when they should have a skin cancer surveillance examination by a dermatology clinician. In the final part of our Skin Cancer Awareness Month series, I review the skin cancer risk factors that may apply to you to consider getting a skin cancer screen.
Skin photo type matters.
If you have a SPT of 1 or 2, red hair, blue or green eyes and freckle easily and/or have numerous moles and your risk increases significantly if you have a history of sunburns or a family history of skin cancer.
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Number of sunburns.
If you have had more than 5 sunburns or have spent any time indoor tanning before age 35 your risk for developing melanoma is increased by 75%, per the Skin Cancer Foundation. The FDA states that indoor tanning devices are carcinogenic contributing to the three types of skin cancers.
Chronic outdoor exposure.
Outdoor workers and outdoor recreational enthusiasts (golfers, tennis players, fishermen, etc.) that spend hours are mostly at risk for squamous cell carcinomas and basal cell carcinomas however they are not excluded from getting melanoma. These skin cancers usually develop in areas of exposed skin such as the ears, heck, face, arms and hands.
Solid organ transplant recipients.
Solid organ transplant recipients take some form of immunosuppressive medication which puts them at risk for many cancers. High-risk Caucasians (risks noted above) should have skin cancer surveillance examinations 2 years after the transplant and at more frequent intervals if they have a history of skin cancer. All other Caucasians, Asians, Hispanic, African Americans should be examined 5 years after the transplant and annually thereafter.
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Numerous moles (nevi).
People with numerous moles are at risk for melanoma and should be educated on how to do self-examinations of their skin. Any unusual, ugly duckling moles should be brought to the attention of their PCP to be referred to a dermatologist. Seventy to eighty percent melanomas are ‘de novo’, meaning they develop on skin without moles, however 20% to 30% develop in existing moles. If there is a family or personal history of skin cancer, you discuss mole mapping with your dermatology provider.
If you have a first-degree relative with a history of skin cancer this increase your risk and being sun safe should be a priority. Or, if you have already had skin cancer, you are at a high risk for developing more skin cancers as you age and self-skin exams and routine skin cancer surveillance should be part of your healthcare maintenance.
New changing moles.
Anyone over the age of 24 with a new, changing lesions on their body not noticed before should seek professional evaluation.
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It is rare for people under the age of 20 to develop skin cancer, however, if at any age, you have one or more risk factors consult your primary care provider to be referred to a dermatology provider.
When scheduling an appointment with a dermatology provider it is important you inform them of your skin cancer risks and you would like a full body skin examination. You can request a spot check or only areas of concern such as only sun exposed areas. It is best to have a full body skin exam as a baseline if you are at risk.
Most dermatology clinicians use a dermatoscope: a handheld 10x magnifier with special polarized and non-polarized lighting, also known as skin surface microscopy. It allows us to evaluate skin lesions for certain patterns and structures that increase the clinician's distinction in diagnosing skin cancers and benign lesions. This reduces unnecessary biopsies and improves identification of skin cancers.
Dermatoscope: hand held device that improves the dermatology clinicians'
diagnostic accuracy of skin lesions.