Self-Exams, Screenings Vital For Skin Cancer Detection
When detected early, most skin cancers can be successfully treated. In fact, melanoma, the most serious form of skin cancer, is highly curable when found and treated early. The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent. However, dermatologists caution that finding skin cancer in its earliest stages requires a commitment by individuals to perform regular skin self-examinations and to report any suspicious moles or unusual changes to their dermatologist immediately.
Now, new research shows that involving a partner in the self-examination process, particularly one with whom an individual has a good relationship, makes it more likely that self screening will happen and can improve the early detection of skin cancer which could lead to a better prognosis.
"The American Academy of Dermatology (Academy) has been a leading advocate of the importance of skin self-exams and free community-based screening events as a means to detecting skin cancer," said dermatologist C. William Hanke, MD, MPH, FAAD, president of the Academy. "Since its inception in 1985, the Academy's National Melanoma/Skin Cancer Screening Program has screened more than 1.8 million people across the country and detected more than 180,170 suspicious lesions. This new research confirms what dermatologists have known for years -- early detection of skin cancer through self-exams and free screenings by dermatologists, whether conducted in the community or in the workplace, can save lives."
Partner-Assisted Skin Self-Exams
In an article entitled "Examination of mediating variables in a partner assistance intervention designed to increase performance of skin self-examination," published in the March 2007 issue of the Journal of the American Academy of Dermatology, dermatologist June K. Robinson, MD, FAAD, professor of clinical dermatology at Northwestern University Feinberg School of Medicine in Chicago, presented findings that patients at high risk for melanoma benefited when a partner was involved in their skin self-exams. Specifically, the patients who were assisted by a partner in performing skin self-exams were more likely to follow a regular detection routine than those who relied solely on themselves for motivation.
Study participants included 130 patients with a history of melanoma who were randomly assigned to either a solo-learning control group or a partner-learning group. Partners were either a spouse of the participant or a person living in the same household as the participant for at least one year prior to the study.
"Our data showed that having a partner assist in skin self-exams led to significantly more positive attitudes toward the importance of skin self-exams, higher reports of self-efficacy or confidence in the ability to perform the exams and more comfort with someone helping to examine their skin compared with those in the solo-learning group," explained Dr. Robinson.
Dr. Robinson's extension of the research about this study group sought to identify if the quality of the relationship with the partner assisting in the skin self-exams would impact the patient's likeliness of performing them. The article entitled "Relationship and partner moderator variables increase self-efficacy of performing skin self-examination," published in the May 2008 issue of the Journal of the American Academy of Dermatology, examined relationship variables that included the quality of the relationship, the partner's motivation, and the partner's ability to provide support and assist in implementing the outlined skin self-exams.
"We concluded that when the quality of the partner or marital relationship was high, the beneficial effects provided by the partner being included in the skin self-exams skills training were the highest -- with patients demonstrating a higher degree of self-efficacy in performing the self-exams," said Dr. Robinson. "Not surprisingly, similar effects were observed for those patients with partners who were motivated to participate and for those with partners who were able to provide a high level of support."
Dr. Robinson added that patients who reported the quality of their relationship with their partner as below average had the lowest levels of self-efficacy in performing routine skin self-exams.
"For patients at high risk for developing melanoma, dermatologists should consider discussing the quality of the patients' relationships with their spouse or partner to determine if they are able to offer adequate support in assisting with the skin self-exams," said Dr. Robinson. "If the quality of the relationship is lacking and the spouse or partner does not offer strong social support to the patient, it might be beneficial to suggest that the patient recruit a different helper, such as a close family member or friend, for assistance."
Workplace Screening Program
The results of a study which may be the only early detection campaign to show a decrease in melanoma-specific mortality were published in the May 2008 issue of the Journal of the American Academy of Dermatology. The study, "Screening program reduced melanoma mortality at the Lawrence Livermore National Laboratory (LLNL), 1984 to 1996," was an educational campaign designed to promote skin self-exams and offer targeted skin cancer screenings for employees at a Northern California workplace. This screening program showed a statistically significant reduction in melanoma mortality and a dramatic 69 percent reduction of intermediate and thick (greater than 0.75 mm) tumors after the initiation of the active screening program. During the same time period, the incidence of these thicker tumors was on the rise in California and the US.
The chief dermatologist for the program for 22 years, Jeffrey S. Schneider, MD, FAAD, who works at the Kaiser Permanente Medical Center in San Rafael, California and is an associate clinical professor of dermatology at the University of California, San Francisco, explained that a threefold to fourfold increased incidence of melanoma during the period 1972 to 1977 was reported among the approximately 5,100 LLNL employees in the local population. "In response to this spike in reported melanomas, we initiated in 1984 a large secondary melanoma prevention campaign of employee education, self-examination, and targeted onsite screenings conducted by a dermatologist," said Dr. Schneider.
Dr. Schneider credits the decline in the number of high-risk melanomas (greater than 0.75 mm thick) detected and the increase in the number easily treatable pre-melanoma and thin melanomas that were caught to the addition of the workplace education, self-examination and screening program. "This study demonstrates that providing this group of motivated, highly educated employees with easily accessible, free onsite screenings was a major factor in the reduction of melanoma-related mortality."
Previously, the assumption that melanoma screening programs saved lives was based on the indirect evidence of increased numbers of thin tumors found. "Now we have much more solid evidence based on mortality reduction, which is the gold standard for measuring the success of any screening program," commented Dr. Schneider.
"To my knowledge, this is the first study to show that dermatologists using commonly practiced techniques of observation and biopsy within an intense education and self-examination program can reduce melanoma mortality," said Dr. Schneider.