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Dermatology Skin Blog: Screening for skin cancer

Should you screen your skin for skin cancers caused by sun UV, such as malignant melanoma? In this blog post, I discuss how you can help detect small skin cancers such as basal cell carcinoma, squamous cell carcinoma and early malignant melanoma.
There is no formal screening programme in the UK for skin cancers, but there is a lot that you can do to help detect skin cancer. It is recommended that people become familiar with their skin. If they notice any changes, they should consult their doctor. Early detection is important, however protecting the skin against damaging UVA and UVB from sunlight is the first line of defence. The three main skin cancers we see are basal cell carcinoma, squamous cell carcinoma and malignant melanoma, which can arise in a previous mole or newly.
Melanoma is a rare but potentially deadly skin cancer, for which early detection is vital as survival is strongly associated with the depth or superficiality of invasion. The deeper or thicker the melanoma is, the more likely it is to metastasise and hence be harder to treat. Therefore, early detection is important.

How can you help detect if you have skin cancer?

You should become familiar with your skin, including the skin which you would not usually think had been exposed to the sun, such as the soles of your feet, the ankles, the groin, the chest and the breasts, as melanoma can occur anywhere on your body. The majority of skin malignant melanomas are in fact detected by patients themselves or by their partners. They can be in a previous mole, which has started to change.
The melanomas detected by physicians tend to be thinner and may not have been suspected by the patient, but the physician notices it based on asymmetry of the shape, the colour changes within it, the contour, irregularity or learning it is a new lesion or one that is changing.
Dr Jennifer Crawley, the Consultant Dermatologist at Clinica London. She does skin mole examination and dermoscopy of suspicious pigmented skin lesions. She will biopsy the lesion if required. However, no analysis or technology such as dermatoscopy is going to reduce the harm caused by skin cancer if it is already there, hence prevention is how we should be thinking. It takes many years
for the skin to be damaged and a skin cancer to appear.

Is screening is recommended to prevent skin cancer?

Actual population-based screening by dermatologists for skin cancers is not recommended, but self-examination is likely to be the key, looking for any change in shape, colour or size of the lesion or the development of a new lesion. However, the exception is people at high risk of developing skin cancer, such as those who have Fitzpatrick type I skin or who are on immunosuppressant drugs for cancer treatment or transplant treatment, who should have regular checks by their skin doctors. These people at high risk of developing
skin cancer can benefit from dermatological screening.
Melanomas that are diagnosed through screening are more likely to be thinner than those that are found by the patient, but we do not know that this definitely reduces the mortality from melanoma because melanoma can spread very early on. In 2012, a German study looked at population-based screening for melanoma using whole body examination by a physician, who then referred suspicious lesions to a dermatologist. Researchers found that they reduced melanoma mortality by just under 50%. Therefore, the medical profession is edging towards population-based screening for melanoma, but currently skin screening for skin cancer is restricted to high-risk patients.
Dermoscopy really helps improve clinicians’ diagnostic accuracy for melanoma compared with other diagnostic approaches. The use of dermoscopy is associated with a diagnosis of thinner melanomas. Once a melanoma has been detected, it needs to be biopsied en bloc and sent for histopathological analysis. See my next blog post about skin biopsy.
If you’re concerned about one of your moles or simply want to get a professional to look at your skin, Jennifer Crawley is the Consultant Dermatologist at Clinica London with a particular interest in dermatology. She is an expert in both adult and paediatric dermatology and has particular interests in research, teaching and leading audit projects.


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