Taking care of your skin is important this summer, not just to avoid signs of aging, but to protect yourself from cancer. Getting annual checkups, keeping an eye on unusual growths, and finding the right expert are all parts of a healthy skin care plan.
But, a new study finds being proactive about who does your skin care checks can also be key. Published this month in JAMA Dermatology, the study found that not all medical professionals are equally able to assess dangerous and benign moles.
The study, led by Dr. Laura Ferris, associate professor in the University of Pittsburgh’s Department of Dermatology, concluded that when compared to dermatologists, physician assistants (PAs) performed more skin biopsies per case of diagnosed skin cancer while at the same time diagnosing fewer melanomas in the early stage (in situ).
Since physician assistants are a growing part of care providers in dermatology, the study finds that not going directly to a specialist can mean irregular growths aren’t caught early.
“I think the art of looking at skin lesions and knowing when to do biopsies and not to — it’s a skill that you develop over your entire career,” said Dr. Barney Kenet, clinical instructor of dermatology at Weill Cornell Medical College and assistant attending physician at New York Presbyterian Hospital.
Researchers reviewed medical records of 33,647 skin cancer screening examinations in 20,270 unique patients who underwent screening at University of Pittsburgh Medical Center-affiliated dermatology offices from January 1, 2011 to December 31, 2015.
They found that for physician assistants to diagnose one case of skin cancer, they needed 3.9 biopsies vs. 3.3 biopsies for dermatologists. In the case of diagnosing one melanoma, physician assistants needed 39.4 biopsies vs. 25.4 for dermatologists.
Plus, people screened by a physician assistant were less likely than those screened by a dermatologist to be diagnosed with the early-stage melanoma in situ — 1.1 percent vs. 1.8 percent of visits. However, that significant difference wasn’t carried over for invasive melanoma or non-melanoma skin cancer, according to the study.
Know your medical history
In light of the study, what can people do to receive optimal care and diagnosis?
Start by arming yourself with information.
“They need to be familiar with their own medical history because any doctor or physician assistant will ask them,” Kenet said.
That includes from the very basics like medications to the more specific skin history.
“Does anybody in your family have skin cancer, especially melanoma?” he said.
Make sure you know the name of the cancer and inform your doctor if death resulted from the cancer, because that will put you in a high-risk category. Also inform the doctor or physician assistant if you’ve ever had any severe sunburns that blistered or caused a visit to the ER — another high-risk factor.
You should always inform the doctor of any diseases, illnesses, or medications in your medical history. If you’re immunocompromised due to diseases or medications, that substantially increases your skin cancer risk, Kenet said.
Perform regular skin checks
It’s also important to know your own skin. Be aware of your moles and freckles, and if they’ve grown or changed in any way. Kenet added, “You don’t have to go crazy with it,” but take a good look at your skin once a season.
“We’re probably talking about 4 minutes a year,” he said.
Things to watch out for include bumpy, black, bleeding, scabby, or asymmetric growths or lesions. Kenet digests it down to one phrase: ugly duckling.
“If something on your skin is getting big and ugly, show it to me,” he said.
Dr. Suzanne Olbricht, president of the American Academy of Dermatology, said it’s also a good idea to take photos on your cell phone to document any moles or growths for comparison’s sake, and also to enlist the help of a friend or loved one during the self-exam to look at areas on your back or other hard-to-see spots.
A recent observational study in JAMA Dermatology found that married patients were more likely to present with early-stage tumors than patients who were never married, divorced, or widowed.
Olbricht said once you’ve brought a lesion to the attention of your doctor, you should expect a full skin exam. If you don’t receive one, you should request it.
Find the right expert
“If there’s something that seems serious, if a biopsy is performed or if you’re not sure, get a second opinion,” said Kenet.
Olbricht said the American Academy of Dermatology has a position statement when it comes to physician assistants: A dermatologist should be present in the office when the PA is seeing patients in order to assist with any diagnostics. She added that if the physician assistant ever wants to do something you’re not comfortable with, ask for the dermatologist.
Kenet said if a biopsy is taken, another key expert is the pathologist who will examine the sample. Most dermatologists will automatically send the biopsy to a dermatopathologist, who specializes in the skin. But a general doctor’s office may send it to a general pathologist, which Kenet doesn’t recommend.
Ask your doctor about who is examining the biopsy and request that it be sent to a dermatopathologist if it isn’t.
“I think that’s a big deal,” he said.