Skin Cancer Awareness Month: Sun Safety and Tackling Diagnosis

Nayoung Lee, MD

May is Skin Cancer and Melanoma Awareness Month and even as awareness of skin cancer grows, the incidence continues to rise. Nonmelanoma skin cancers, including basal cell and squamous cell carcinoma, affect more than 3 million Americans each year,¹ and the American Cancer Society estimates that about 100,000 new melanomas will be diagnosed in 2024.²

Further, skin cancer poses a disproportionate risk in Black patients vs White patients with melanoma as 5-year survival rates are 70% compared with 94%. Additionally, melanoma in patients of color typically occurs in areas that get little sun exposure.³

In an interview with Targeted Oncology^TM, Nayoung Lee, MD, assistant professor of dermatology at NYU and assistant program director of the residency program, discussed evolving paradigms in skin cancer diagnosis and prevention and highlighted the importance of sun safety and regular screenings.

Cross section of melanoma cells in skin

Targeted Oncology: How often would you recommend conducting a self-exam or getting a skin exam?

Lee: Self-exams, it is up to the patient and how nervous they are about it. Self-exams are great because you do it yourself at home, so you can do it as frequently as you want. But in the clinic, we recommend at least once a year skin exam for patients without a history of skin cancer and at least every 3 to 6 months for patients with a history of skin cancer. Most skin cancers usually do not grow that quickly, so it is not like you have to check yourself like every week or every month.

What would be the signs of a concerning sign or blemish, and when should a patient see a dermatologist?

It depends on if you are looking for it, if you are worried about melanoma or nonmelanoma skin cancer, because those look very different. Nonmelanoma skin cancers are more common than melanomas. Oftentimes patients come in with this history of like, “oh, I thought it was just a pimple,” or “I thought I nicked myself shaving,” or “it kind of bled when I scratched it, so I thought it was like a nothing but it came back over and over again and just never went away.” Anything that is bleeding when minimally touched is a concerning sign. Of course, benign things can also bleed when they are irritated and scratched, but anything that is new and bleeding, you should come in for. [Also], any kind of scaly areas that are not healing over. Those are the most common kind of presentations of nonmelanoma skin cancer.

In terms of moles, the ABCDEs of melanoma are well known at this point. A being asymmetry. B, border, sort of irregular, scalloped or jagged borders, a little bit concerning for melanoma. Color, anything with multiple colors like black, brown, blues, that is also concerning. Diameter, so larger than the head of a pencil eraser. And E is for evolution, so anything that is changing. If you have one of those things, it is not like you have to rush to the dermatologist’s office, but if you have multiple of those things that you are checking off, then that is a sign that you should go to your dermatologist for a checkup. A majority of melanomas do not start from a preexisting mole, so oftentimes it would be a brand-new dark spot that you are seeing.

What is your opinion on incorporating artificial intelligence [AI] tools in diagnosing skin cancers?

I think that they're going to be a useful tool just to get patients into the door to their dermatologist clinic. I think there are so many different kinds of apps and programs now where you can take pictures of a mole or something concerning on the skin and then it spits out into differential diagnosis. I think that especially in areas where you do not have access to dermatology or you have limited access to dermatology, it can be great. It can be a great tool, especially for primary care doctors to use when we are seeing patients. I do not think we can rely on those things 100% right now. I do not think the technology is there yet. But I think they can play a role in patient care for patients with skin cancer.

What are the most important sun safety tips?

Sunscreen is going to be your most important thing. Oftentimes, patients are not even applying their sunscreen correctly. You do have to apply a lot more than you would think,and you have to reapply. I know it is very unrealistic, and I have to admit, I am bad at reapplying myself, but you could also practice other sun safety measures like wearing sun protective clothing, not just relying on your sunscreen, [or] trying to stay kind of out of the sun during the hottest times of the day. For example, New Yorkers tell me that they try to walk on the shaded side of the street.

I think there are also kinds of supplements that you can buy over the counter derived from plant extracts that you can take that have shown that have been shown to have protective benefits in large studies. They are not going to be a replacement for sunscreen, but they are a good adjunctive therapy that patients can take.

There is also nicotinamide. There was a large trial showing decreased risk of getting cancer if you take nicotinamide 500 mg twice a day. If you are worried [or] you have a history of skin cancer and you have had multiple skin cancers in the past, I would suggest those supplements. But for the average person, I think sunscreen, being good about reapplication, [and] using some protective clothing, I think that's plenty.

We have seen that rates of skin cancer have increased. Do you think we are experiencing more genuine diagnoses of skin cancer? Or is it that the diagnosis of skin cancer is improving?

I think it could potentially be both. But I think we are detecting more now because more people are becoming aware of skin cancer and going to their dermatologist. Also, I think we have gotten good at doing biopsies using dermoscopy. Whether or not it is going to make a difference in the long run in deaths from these serious skin cancers, I do not know. I think because we are getting so good at diagnosing, I think we are diagnosing a lot of these skin cancers in their early form or less aggressive forms.

More patients of color are being diagnosed with skin cancer. Again, I am not really sure if more people are developing skin cancer. I mean, it is true that tanning bed use is still a thing, so I do think more and more younger patients are getting a diagnosis of skin cancer, but we are finding more skin cancers in the skin of color population. [In our] skin of color section, we are seeing and taking care of skin of skin of color patients for various conditions that disproportionately affects people of color.

REFERENCES:

1. Skin cancer. American Academy of Dermatology Association. Updated April 22, 2022. Accessed May 10, 2024. https://tinyurl.com/yfwf3n5n

2. Key statistics for melanoma skin cancer. American Cancer Society. Updated January 17, 2024. Accessed May 10, 2024. https://tinyurl.com/y9fuxe4a

3. Skin cancer in people of color. Dartmouth Geisel School of Medicine. Accessed May 10, 2024. https://tinyurl.com/54sz9pv3