A visual skin examination performed by a dermatologist who can make an accurate assessment of a suspicious skin lesion and determine whether it warrants a biopsy is critical for the early detection of cancer and for saving lives.— Deborah S. Sarnoff, MD, FAAD, FACP
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The statistics on the rising rates of skin cancer are alarming. According to the Skin Cancer Foundation, each year over 5.4 million cases of nonmelanoma skin cancer are treated in more than 3.3 million people, and an additional 76,380 people are diagnosed with the deadliest form of skin cancer, melanoma, which kills over 10,000 people annually—squamous cell carcinoma, the second most common skin cancer, kills nearly an equal number of people, 8,800 per year.1
Since its launch almost 4 decades ago by its founder, Perry Robins, MD, the Skin Cancer Foundation has had as its primary mission to educate the public and the medical community on the dangers of exposure to ultraviolet radiation from the sun and skin cancer risk and the importance of preventive strategies, early detection, and treatment. To help accomplish those goals, in 2008, the Foundation initiated the Road to Healthy Skin Tour, which utilizes a customized RV outfitted with private exam rooms and volunteer dermatologists to reach people in small communities nationwide for free skin cancer screenings. Since the program began, more than 21,000 people have received screenings, and 9,000 suspected skin cancers have been found.
In 1981, the Foundation inaugurated the Seal of Recommendation program, which reviews the results of laboratory testing on sun-protective products, including sunscreens. A volunteer team of scientific advisors ensures that these products meet the Foundation’s specific criteria for effective sun protection.
This past October, Dr. Robins, Professor Emeritus of Dermatology and former Chief of the Mohs Micrographic Surgery Unit at New York University (NYU) Medical Center, announced he would be stepping down as head of the Skin Cancer Foundation and named Deborah S. Sarnoff, MD, FAAD, FACP, as its new President. Dr. Sarnoff, Clinical Professor of Dermatology at New York University (NYU) Medical Center, had previously served as the Foundation’s Senior Vice President.
In 1985, Dr. Sarnoff, then a resident at NYU Medical Center, began a 1-year fellowship with Dr. Robins for training in Mohs micrographic surgery and is now a leading expert in the procedure, performing over 1,000 Mohs surgeries a year in her private dermatology practice in New York City and on Long Island. “Basal cell and squamous cell skin cancers can be deforming, but fortunately we can eliminate the cancer with Mohs surgery, reconstruct the defect, and have a high cure rate. But melanoma is more difficult,” said Dr. Sarnoff. “Our goal is to be able to save more lives.”
The ASCO Post talked with Dr. Sarnoff, who began her term as President on January 1, about her goals for the Foundation and her greatest challenges.
Goals and Challenges
As you begin your new role as President, what are your goals for the Skin Cancer Foundation, and what are some of the challenges the Foundation faces?
Our most important goal—and our greatest challenge—is to see the rates of skin cancers, especially melanoma, start to decline. In 2015, Australia, a country with one of the highest incidences of melanoma in the world,2 passed a law banning tanning salons, and that’s what I would like to see happen in the United States. Currently, several states, including California, Delaware, Hawaii, Illinois, Louisiana, Minnesota, Nevada, New Hampshire, North Carolina, Oregon, Texas, and Vermont, ban the use of tanning beds for minors under age 18. Here in New York, minors under age 17 are banned from using tanning beds. We need laws that ban the use of tanning beds altogether, for everyone. According to a study in 2014,3 more than 419,000 cases of skin cancer may be related to indoor tanning in the United States each year, causing 245,000 basal cell carcinomas, 168,000 squamous cell carcinomas, and 6,200 melanomas.
At the Foundation, we have several campaigns aimed at discouraging indoor and outdoor tanning, including Go With Your Own Glow. This program encourages women to embrace whatever skin color they have and to protect their skin from ultraviolet rays, whether from the sun or tanning beds.
We would especially like to see tanning beds banned on college campuses and at health clubs, because it’s an oxymoron to go to a health club to be healthy and then use a tanning bed to bake your skin and risk developing skin cancers in the future. We also have campaigns aimed at young children in elementary school about the importance of using sunscreen and wearing protective clothing during outdoor playtime.
All these endeavors get to the heart of our three-part mission: to prevent skin cancer; detect skin cancer early when it is most curable; and provide information about treatment options. There have been so many treatment breakthroughs in melanoma over the past 2 years, and we post all of the latest information on our website
(skincancer.org). We will continue to fulfill these tenets of our mission.
Routine Skin Exams
What are some other goals you hope to achieve?
Some studies evaluating whether routine body checks are effective in detecting skin cancer and in reducing mortality have been inconclusive,4 but I believe that a visual skin examination performed by a dermatologist who can make an accurate assessment of a suspicious skin lesion and determine whether it warrants a biopsy is critical for the early detection of cancer and for saving lives. It can be difficult for lay people to spot changing moles on the back or on other difficult-to-see areas, which is why it is important for people to have routine skin examinations by a dermatologist.
I fear the day might come when health insurance won’t cover routine skin exams for people without a history of skin cancer. Where the biopsied tissue is sent for pathology examination is also crucial, because a pathologist who is not trained in dermatopathology might misdiagnose a skin cancer.
It is very important to advocate on a national level for the rights of the public to see a dermatologist, to have the visit covered by health insurance, and to have insurance cover the cost of sending the tissue to a dermatopathologist for evaluation. These are two issues we may be taking on in the future. We have a long battle to fight, and I’m happy to be at the helm during this time.
Heads Up! Program
Please talk about why you launched the educational program Heads Up! to enlist the aid of hair stylists to help detect potential skin cancers on their clients’ scalps.
I get my hair cut and colored once a month, and one day while my hair was being washed, the shampooist said I had a black spot on my scalp that wouldn’t wash off. I asked her to take a photo of it on her cellphone, and it looked like melanoma. I was terrified. My husband, who is a plastic surgeon, removed the lesion, and fortunately the pathology report showed it was a completely benign tumor called blue nevus.
It was foolish of me never to have checked my scalp, and the experience made me realize how important it is for dermatologists to educate beauty professionals about skin cancer and how to talk to their clients if they see a suspicious mole or lesion on their skin or scalp.
Heads Up! has been a very successful and rewarding program for the Foundation. Hairdressers and barbers are on the front lines in helping to detect potential skin cancers; to give them the tools they need to be successful, we provide them with materials about skin cancer and its warning signs and host an educational event with a dermatologist who can answer questions and demonstrate the signs of skin cancer.
Funding Skin Cancer Research
Does the Foundation fund skin cancer research?
Yes, but it’s not our primary focus. Our top focus has always been on skin cancer education, prevention, early detection, and treatment. We have funded more than $1.5 million in research grants to date, and in 2016 we awarded a total of $75,000 in research grants to three physicians conducting innovative research. Researchers can learn more about the program by visiting www.skincancer.org/research.
We want to become more well known among the oncology community to alert them to potential funding opportunities and, most important, to provide oncologists with a resource for their patients with cancer. ■
Disclosure: Dr. Sarnoff reported no potential conflicts of interest.
1. Skin Cancer Foundation: Skin Cancer Facts & Statistics. Available at www.skincancer.org/skin-cancer-information/skin-cancer-facts. Accessed January 3, 2017.
2. Melanoma Institute Australia: Melanoma Facts and Statistics. Available at www.melanoma.org.au/understanding-melanoma/melanoma-facts-and-statistics. Accessed January 3, 2017.
4. Wernli KJ, Henrikson NB, Morrison CC, et al: Screening for skin cancer in adults: An updated systematic evidence review for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality (US); 2016 July Report No: 14-05210-EF-1. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.