Skin Cancer – Education is the Key to Early Detection

Skin Cancer – Education is the Key to Early Detection

Skin cancer education and early detection at the beach: a randomized trial of dermatologist examination and biometric feedback.

Emmons KM, Geller AC, Puleo E, Savadatti SS, Hu SW, Gorham S, Werchniak AE; Dana-Farber Skin Cancer Screening Group.

J Am Acad Dermatol. 2011 Feb;64(2):282-9. Epub 2010 Dec 15.

• Skin cancers are mostly related to cumulative sun exposure. Treating them at the earliest is a good thing but the best would be to prevent their appearance by sun avoidance and sun protection. Sun exposure management not only limits skin diseases but also slows down skin aging, more precisely photoaging. The big question is how to get people to do this.

• In this interesting study done on beaches (in a Van) in the Boston area in the summer, 4 strategies were compared in 668 patients. Around a quarter of each was randomly assigned in a strategy:

1. 0-education only: explanation of basic skin cancer knowledge as well as explanatory brochures on sun protection
2. 1-education + biometric feedback: in addition a Dermascan of the face and head was done. This can be compared to Wood’s light (365nm, black light). It shows clumping of melanin and thus UV induced damage. A photograph is taken and given at the end of the meeting.
3. 2-education + examination of the skin by a dermatologist
4. 3-education + biometric feedback + examination of the skin by a dermatologist.

• Evaluation of the likelihood of adopting sun protection attitudes was evaluated by questionnaire at the end of the summer. (visit of a dermatologist and biopsies…was also evaluated)

• Results: Compared to education only odds ratios were of 1.97 (1), 1.94 (2) and 1.07 (3) respectively

• Discussion:

1. The study was carried out in a high-risk sun seeking population. Contrarily to the authors, we do not think that the examination of the skin by a dermatologist will stop patients from adopting sun exposure management. Education + Biometric feedback (1.97) and Education + examination of the skin by a dermatologist (1.94) show similar odds when compared with education alone.
2. However education + biometric feedback + examination of the skin by a dermatologist has the same effect as education alone (odds ratio: 1.07).

• To conclude we still think:

1. education + examination of the skin by a dermatologist (2) is the best as it also enables secondary prevention: that is screening of the skin and treatment of skindamage/skin cancers in their early stages.
2. Repeating oneself twice (biometric feedback + examination of the skin by a dermatologist) cancels the induction of preventive behaviour. It might give the impression that there is uncertainty/lack of self-confidence of science/dermatologists or that the high risk population is being educated in an aggressive way by inducing fear.

“What is thoroughly understood  will not repeat itself .” Krishnamurti. But what you can’t learn is common sense.