Skin cancer screening: Clinical sciences

Skin cancer is one of the most common cancers in the United States. It is estimated one in five individuals will develop some form of skin cancer within their lifetime. So, prevention is the most important way to limit the risk of developing skin cancer. Some of the most effective preventative methods include decreasing exposure to UV rays from sunlight by wearing sun-protective clothing and using broad spectrum waterproof sunscreen with an SPF of 30 or higher, as well as avoiding artificial UV rays like tanning beds. Because complete avoidance of UV rays is are not feasible, regular skin cancer screenings, which include risk factors assessments and skin exams, are used to identify individuals more susceptible for developing skin cancer.

Alright, when a patient presents for a skin cancer screening, the initial step is to assess their risk factors for future skin cancer. Individuals at an increased risk for developing skin cancer include those who are older than 50 years; as well as sun-sensitive individuals with red or blonde hair, light eye color, light skin pigmentation, or freckling.

Other important risk factors include a nevi count that is greater than 50 with or without large, atypical nevi; as well as personal or family history of skin cancer; and immunosuppression or chronic immunosuppressive therapy. Lastly, there’s an increased risk for skin cancer in patients with certain syndromes and genetic disorders, such as xeroderma pigmentosum or albinism.

Now, if your patient does not have any of the risk factors mentioned above, then they are considered to be at low risk of developing skin cancer and no routine screening examination is recommended. Keep in mind, however, any suspicious skin lesions on these patients should be checked regularly by their primary care physicians or evaluated by a dermatologist.

On the other hand, if your patient has any of the risk factors mentioned previously, they are considered to be at a high risk for developing skin cancer. These individuals should undergo annual screenings, which include a total body skin examination with a source of bright light and a magnifying lens.

Trained physicians may also use a dermatoscope, which is a tool that can magnify skin lesions and emit a special light to help detect features that are not visible to the naked eye. For example, a dermatoscope can show you subsurface skin structures within the epidermis, dermoepidermal junction and the papillary dermis. Visualizing these structures can increase the diagnostic accuracy of suspicious lesions.

Now, let’s talk about the physical examination. During the total body skin exam, the scalp, face, head, neck, arms, hands, and axillae are assessed for any lesions. Make sure to examine your patient in the supine position while inspecting the chest, abdomen, lower extremities, and toe webs; and prone position when evaluating the back, buttocks, lower extremities, and soles of the feet.