WAIKOLOA, HAWAII – Improved early detection of fast-growing, lethal melanomas will require out-of-the-box thinking, such as providing dermatoscopes for patients to use at home and educating hairdressers and other nondermatologists on how to detect melanoma.
"At least three companies are now designing dermatoscopes for patient use. Patients will be able to buy the dermatoscope at a pharmacy and do self-examination or examine their spouse. That, I think, is going to be a reality within the next 5 years," Dr. Ashfaq A. Marghoob predicted at the Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation (SDEF).
A key feature of these devices will be the capability of hooking into a smart phone for wireless transmission of suspicious images to a skin cancer expert for assessment.
Dr. Marghoob and his coworkers first proposed dermoscopy as a tool with untapped potential for skin self-examination in selected patients in an article last year (Arch. Dermatol. 2011;147:53-8).
But patient empowerment is only part of what’s needed in order to improve early detection of the fast-growing killer subtype of melanoma. Dr. Marghoob and his coworkers are now conducting a prospective study to evaluate the impact of a 20-minute education session for hair care professionals about how they can aid in detecting skin cancers on the scalp, neck, and face.
This study was a direct outgrowth of a survey the investigators conducted at a Houston convention of barbers and hairstylists. Forty-nine percent of respondents indicated they were highly receptive to participating in a skin cancer education program. During the preceding month, 37% of respondents had looked at more than half of their customers’ scalps for suspicious lesions, 29% had looked at more than half of their customers’ necks, and 15% had checked more than half of their customers’ faces (Arch. Dermatol. 2011;147:1159-65).
Melanoma of the scalp and neck accounted for 10% of all melanoma deaths in the United States from 1973 to 2003. Barbers and hairstylists are in a unique position to detect skin cancers in those locations because they typically see their customers on a regular basis, spend a fair amount of time with them at each visit, have good rapport, and often discuss health issues.
The larger goal underlying this project, Dr. Marghoob explained, is to develop a cadre of expertly trained lay community workers to examine areas of the skin that are difficult for people to see for themselves and which often go overlooked by physicians. In addition to hair professionals, other workers ideally suited to serve as lay skin cancer educators and examiners include massage therapists, manicurists, cosmetologists, and electrologists.
Dr. Marghoob has also been involved in efforts to teach dermoscopy to primary care physicians and other nondermatologist physicians, including ob.gyns., pediatricians, and plastic surgeons. Moreover, he recently conducted a study in which second-year medical students were issued dermatoscopes and trained in their use.
"We found they get better at diagnosing skin cancer and are paying more attention to the skin. All we really want them to do is really look at the skin while they’re doing a physical examination," he said.
He has also been encouraging internists and family physicians to take advantage of opportunistic skin screening situations. For example, when they’re listening to the lungs and heart with a stethoscope, he urges primary care physicians to have patients take their shirt off so they can take a close look at the truncal skin rather than simply slip the bell of the scope underneath the shirt.
Another potentially fruitful means of improving upon the gains achieved in early detection of skin cancer would be targeted screening of older men, a high-risk group for fast-growing nodular melanomas, Dr. Marghoob added.
He reported having no financial conflicts. SDEF and this news organization are owned by Elsevier.