Skin Cancer Care Research Articles

Medicolegally safe skin cancer care requires improvement of referral mechanisms.

Medicolegally safe skin cancer care requires improvement of referral mechanisms.

Skin Cancer Care in US Veterans—Serving Those Who Served

Skin Cancer Care in US Veterans—Serving Those Who Served

"One blade, two cuts?" A multidisciplinary survey investigating practice variability of scalpel blade change forsimultaneous excision of multiple skin lesions in the same patient.

Skin cancer incidence increases globally, requiring effective preventive measures and evidence-based treatment strategies. Current guidelines advocate for surgical excision as a first-line treatment for most early skin cancers. The study investigated practices regarding changing scalpel blades when excising multiple skin lesions in the same patient during the same visit (CSB) and explored how beliefs about iatrogenic seeding influence individual norms of practice. A multidisciplinary survey was conducted among 173 medical specialists involved in skin cancer care. Participants provided demographic information, years of experience, and practices regarding CSB in four clinical scenarios (first excised tumor: basal cell carcinoma, squamous cell carcinoma, melanoma suspect, and evident melanoma). Practice variations based on specialty, experience, and beliefs about seeding risk were statistically assessed. Surgeons exhibited a significantly higher tendency to change blades compared to non-surgeons across all diagnoses. Iatrogenic seeding (56.52%) and clinical training (18.84%) were the main reasons provided for CSB. Beliefs about seeding risk did not differ significantly between specialties. Although the practice of CSB lacks strong scientific rationale, the approach to this practice significantly varies among different medical specialties. Healthcare professionals should critically evaluate and standardize evidence-based practices to ensure optimal patient care and mitigate potential harm.

Quality measures in primary care skin cancer management: a qualitative study of the views of key informants

ObjectivesThis study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation.DesignSemistructured interviews and qualitative proforma surveys were...

Multidisciplinary patient-centered approach to the management of skin cancer.

In recent years, new approaches for optimal patient management of cancer have focused on patient-centered care, with integration of tumour-directed treatment and patient-directed supportive and palliative care throughout the disease journey from prevention through screening, diagnosis, treatment, and follow-up. In 2022, at the International Forum of Dermatology (IFD), a scientific session was entirely dedicated to highlight recent developments on patient-centered approaches in skin cancer. An international panel of different groups of participants involved in a patient's journey on the management of skin cancer presented and discussed challenges and barriers that persist in the field of skin cancer prevention and care pathways. Although primary prevention remains a crucial step in the prevention of melanoma, the different surveys performed during the last 20 years demonstrate that the use of sunscreen increases very slowly. Secondary prevention that includes skin screening and diagnostic measures may benefit from the development of digital tools. To improve adherence, patients need accurate, reliable information about their disease and the treatment options, and this type of content that can also be made available on digital tools. Shared decision-making is a hallmark of a patient-centered approach and requires health care providers who can communicate well to patients and their families, underscoring the pivotal role of health care professionals all through the patient journey. Health care providers have a crucial role in supporting patients through their journey in skin cancer. They will benefit from mobile apps and technologies that have been developed recently to address challenges in skin cancer prevention, detection and care, including those that are primarily directed to the patient. However, more peer-reviewed studies are needed as well as regulations to ensure that apps are accurate, reliable, and up to date.

Championing Diversity in Mohs and Cutaneous Oncology: Reducing Disparities in Skin Cancer Care for Patients of Color.

Skin cancer is the most common type of cancer affecting people in America. Skin cancer grows in patients from many diverse racial and ethnic backgrounds. Research shows that there are significant disparities that exist in the diagnosis and treatment of skin cancer for patients of color. Patients of color have lower incidence but higher rates of mortality for certain types of skin cancers. This article expounds on the role of diversity in Mohs surgery and cutaneous oncology to improve medical outcomes and address these health care disparities. By training an oncology workforce that has increased representation and improved cultural competence, the health care system can collaborate to achieve health equity in the treatment of skin cancer. Through both collaboration and advocacy, the oncology field can create an inclusive health care system that prioritizes the needs of all patients.

The Burden of Skin Cancer in the Military Health System, 2017-2022.

This retrospective observational study investigates skin cancer prevalence and care patterns within the Military Health System (MHS) from 2017 to 2022. Utilizing the MHS Management Analysis and Reporting Tool (most commonly called M2), we analyzed more than 5 million patient encounters and documented skin cancer prevalence in the MHS beneficiary population utilizing available demographic data. Notable findings included an increased prevalence of skin cancer in the military population compared with the civilian population, a substantial decline in direct care (DC) visits at military treatment facilities compared with civilian purchased care (PC) visits, and a decreased total number of visits during COVID-19 restrictions.

Clinicopathologic comparison of basal cell carcinoma among a diverse patient population in Los Angeles County.

Basal cell carcinoma (BCC) is the most common malignancy in the United States. The majority of cases are identified in Non-Hispanic Whites (NHW) and are far less demonstrated in patients of colour (POC). However, the Hispanic population represents a large and growing proportion of the US population, and skin cancer diagnoses in Hispanics are rising. Thus, the goal of this study is to examine clinicopathologic differences between BCC in Hispanics versus NHW. A retrospective chart review of Hispanic and NHW patients with BCC at Los Angeles County+USC Medical Center from January 2018 to March 2020 was performed. In total, 101 BCC samples from the first 100 patients identified of Hispanic ancestry, as well as 50 BCC samples identified from the first 50 patients identifying as NHW, were included for analysis. Patient characteristics (age, sex, medical history, and ethnicity), as well as tumour characteristics (location, subtype, tumour depth, and perineural invasion), were collected. We used between subjects t-tests for continuous variables, and chi-square tests for categorical variables. In total, 151 specimens were collected amongst 122 subjects (79 Hispanics and 43 NHW patients). Among NHW, the majority of patients (74.4%) were men, but among the Hispanic population, the majority (68.4%) were female (p<0.001). Prior history of other skin cancer was more common among NHW (67.4%) than Hispanics (31.6%) (p=<0.001). The Hispanic population had a significantly higher proportion of head and neck tumours (p=0.0004) but a lower proportion of extremity tumours (p=0.001) compared to NHW. Pigmented BCC was significantly more common among Hispanic patients (p<0.01). Finally, within the Hispanic group, there was a significant association between sex and histology (p=0.004), with Hispanic men demonstrating more aggressive mix histology compared to Hispanic women. Our study supports the notion that BCC disparities occur among POC compared to NHW. This includes variations in epidemiologic factors such as sex and past medical history, primary tumour location, and pathologic characteristics. Further research should be conducted to identify additional differences in skin cancer presentation in POC to reduce the gaps in skin cancer knowledge and care.

Cutting-Edge Innovations in Minimally Invasive Techniques for Skin Cancer Treatment

Skin cancer is a common and possibly deadly disease that requires immediate and efficient treatment. Conventional surgical methods, although successful, frequently lead to the formation of scars and extended periods of recuperation. In recent years, there have been significant developments in minimally invasive treatments for treating skin cancer. These techniques provide patients with alternative options that result in better cosmetic outcomes and shorter recovery periods. This article is a comprehensive summary of state-of-the-art advancements in minimally invasive procedures, including as laser therapy, cryotherapy, electrochemotherapy, and radiofrequency ablation. We analyze the benefits of these procedures, including minimized scarring, improved cosmetic outcomes, and faster healing periods, while also examining the difficulties and factors involved in their application. We showcase the concrete advantages that patients receive when they undergo minimally invasive therapy for skin cancer, using case studies and success stories as evidence. In addition, we examine potential future paths in research and development, anticipating a favorable outlook for the ongoing use of minimally invasive methods in the treatment of skin cancer. The global prevalence of skin cancer is a substantial health issue, leading to continuous progress in treatment strategies aimed at enhancing patient results. Conventional surgical techniques, however efficient, can lead to conspicuous scarring and extended recuperation periods. Recent advancements in minimally invasive procedures have significantly transformed the treatment of skin cancer, providing patients with alternative options that yield better esthetic results and shorter recovery periods. This article offers a comprehensive analysis of state-of-the-art advancements in minimally invasive procedures, encompassing laser therapy, cryotherapy, electrochemotherapy, and radiofrequency ablation. We use case studies and success stories to demonstrate the concrete advantages that patients gain from these operations, such as minimized scarring and improved cosmetic outcomes. In addition, we explore the difficulties and factors to take into account when putting these methods into practice, along with potential areas for further investigation and advancement. Our goal is to emphasize the hopeful future of minimally invasive treatments in skin cancer care, which will ultimately enhance patient experiences and outcomes.

Skin in the game: The cost consequences of skin cancer diagnosis, treatment and care in Northern Ireland

BackgroundSkin cancer is a prevalent cancer in the UK. Its rising incidence and mortality rates are expected to result in substantial financial implications, particularly on diagnostic and treatment services for skin cancer management in Northern Ireland (NI). Such anticipated disease increases underscore the need for prevention and control measures that should help guide policymaking and planning efforts. MethodsWe conducted a cost of illness study to assess the economic impact of skin cancer in NI from the healthcare system's perspective, using a bottom-up method, employing NHS reference costs (UK£) for skin cancer diagnosis and treatment patient pathways in 2021/22. Sensitivity analyses varied diagnostic volumes by applying multipliers for benign cases, assuming a diagnostic conversion rate of 6.8%, and examined an alternative chemotherapy regimen compliance rate of 75%. Additionally, proportional cost increases were projected based on future estimated increases of 9% and 28% to malignant melanoma (MM) cases for diagnostic, treatment, and follow-up volumes. ResultsSignificant numbers of non-melanoma skin cancers (NMSC) and MM cases were recorded, 4289 NMSCs and 439 MM cases. The total cost for managing NMSC was £ 3,365,350. Total costs for MM skin cancer were £ 13,740,681, including £ 8,753,494 for procurement, administration, and chemotherapy drug use. Overall healthcare spending on skin cancer care totalled £ 21,167,651. Sensitivity analysis suggested diagnostic cost may increase significantly to £ 12,374,478 based on referral volume assumptions. If base case rates rise by 9 or 28% estimated total costs of treating skin cancer will increase to £ 22.3 million and £ 24.9 million, respectively. ConclusionsSkin cancer management costs in NI totalled ∼£ 21.1 million to £ 32.1 million, depending on diagnostic referral assumptions. Costs have risen ∼10-fold over the past decade for MM due largely to chemotherapy costs. A predicted 28% increase in MM cases by 2040 would lead to ∼£ 3.8 million of additional expenditures, providing a significant challenge for cancer health systems.

Gaining experience in the provider role: Exploration of a novel simulation intervention to prepare nurse practitioner students to detect and manage skin cancer.

The high prevalence and negative outcomes associated with skin cancer demand effective strategies to prepare nurse practitioner students to detect cancerous lesions and manage patient care. However, few studies have examined dermatologic simulations to prepare nurse practitioner students to detect and manage skin cancer. An exploratory-descriptive qualitative approach was used to examine nurse practitioner students' experiences with simulations involving standardized patients wearing three-dimensional (3-D) prosthetic skin lesions, perceptions of ability to apply the simulations to clinical practice, and preferences for learning dermatologic care. A convenience sample of 39 nurse practitioner students participated in simulations with standardized patients wearing 3-D skin lesions. Focus groups were conducted following simulation participation, and thematic analysis was performed by two researchers. Four themes emerged: Simulation provides a safe place to practice , Dermatology should be an integral part of education , Realism makes a difference , and Improved confidence and preparation for practice . Simulations with standardized patients wearing 3-D skin lesion prosthetics provided students the opportunity to assess, diagnose, and manage the care of patients with cancerous skin lesions. Participants valued the realistic practice with dermatologic care and reported improved confidence and preparation for practice. Faculty can use simulations to provide experiential learning about the provider role in general and as it pertains to skin cancer care. Attention to realism is important to aid in building students' confidence and preparation for practice.

Implementing systematic melanoma risk assessment and risk-tailored surveillance in a skin cancer focussed dermatology clinic: A qualitative study of feasibility and acceptability to patients and clinic staff.

International bodies recommend that melanoma risk assessment should be integrated into skin cancer care provision, but evidence to support implementation is lacking. To explore the acceptability and feasibility of implementing personalised melanoma risk assessment and tailored patient education and skin surveillance within routine clinical care. This prospective qualitative implementation study was informed by the Theoretical Framework of Acceptability (TFA). Personalised, systematic melanoma risk assessment was implemented in the dermatology clinic at the Melanoma Institute Australia, Sydney, Australia February-May 2021. Pre- and post-implementation observations and semi-structured interviews with patients and staff were conducted (September 2020-March 2021). Observational notes and interview transcript data were analysed thematically using the TFA as a classifying framework. A total of 37 h of observations were made, and 29 patients and 12 clinic staff were interviewed. We found that the delivery of personalised melanoma risk estimates did not impact on patient flow through the clinic. Dermatologists reported that the personalised risk information enhanced their confidence in assessing patient risk and recommending tailored surveillance schedules. Most patients reported that the risk assessment and tailored information were a beneficial addition to their care. Among patients whose risk deviated from their expectations, some reported feeling worried, confused or mistrust in the risk information, including those at lower risk who were recommended to decrease surveillance frequency. It is feasible and acceptable to patients and clinic staff to calculate and deliver personalised melanoma risk information and tailored surveillance as part of routine clinical care within dermatology clinics.

The role of nursing care in the management of post-burn epidermal cancer: A narrative review

Severe burns, affecting over 20% of the body, induce systemic dysfunction and immune suppression, correlating with increased cancer risk, especially skin cancer. Nurses play a crucial role in averting complications, which is explored in this study through a comprehensive literature review. The literature review focused on nursing care for post-burn skin cancer; a systematic search covered databases including Magiran, Scientific Information Database, and PubMed and Google Scholar search engine. Keywords "nursing", "skin cancer", and "burn" were strategically combined with Boolean operators. From an initial 580 articles, 10 met eligibility post-screening. The results have shown that optimal care for burn patients necessitates an interdisciplinary approach with the burn nurse at its core, coordinating patient care across multiple disciplines. The nurse's responsibilities encompass a comprehensive understanding of multisystem organ failure, critical care methodologies, diagnostic procedures, and psychosocial skills. Meticulous wound care, infection prevention, and pain management are pivotal, with the nurse actively engaging in nursing research. The origin of cancers within burns involves hypotheses of persistent cell proliferation, chronic inflammation, toxin exposure, and compromised immunological defense. Nursing care, particularly in detecting and treating wound inflammation, is pivotal in preventing cancer. Nurses contribute to patient education on skin cancer prevention, emphasizing lifestyle choices and providing crucial psychological support. Nursing diagnoses, based on symptomatology studies, include "risk for impaired skin integrity", "impaired skin integrity", "acute pain", "chronic pain", and "impaired comfort". These diagnoses guide tailored interventions to prevent skin cancer incidence.In sum, nurses are pivotal in comprehensive burn care, overseeing wound care, infection prevention, and patient education on UV radiation dangers. They advocate healthy lifestyles to reduce skin cancer risk, provide psychological support, and encourage commitment to prevention practices. Nursing diagnoses guide tailored interventions, contributing to ongoing improvements in burn care and enhancing the quality of life for survivors.

Telehealth Availability for Cancer Care During the COVID-19 Pandemic: Cross-Sectional Study.

Telehealth was an important strategy for maintaining continuity of cancer care during the coronavirus pandemic and has continued to play a role in outpatient care; however, it is unknown whether services are equally available across cancer hospitals. This study aimed to assess telehealth availability at cancer hospitals for new and established patients with common cancers to contextualize the impact of access barriers to technology on overall access to health care. We conducted a national cross-sectional secret shopper study from June to November 2020 to assess telehealth availability at cancer hospitals for new and established patients with colorectal, breast, and skin (melanoma) cancer. We examined facility-level factors to determine predictors of telehealth availability. Of the 312 investigated facilities, 97.1% (n=303) provided telehealth services for at least 1 cancer site. Telehealth was less available to new compared to established patients (n=226, 72% vs n=301, 97.1%). The surveyed cancer hospitals more commonly offered telehealth visits for breast cancer care (n=266, 85%) and provided lower access to telehealth for skin (melanoma) cancer care (n=231, 74%). Most hospitals (n=163, 52%) offered telehealth for all 3 cancer types. Telehealth availability was weakly correlated across cancer types within a given facility for new (r=0.16, 95% CI 0.09-0.23) and established (r=0.14, 95% CI 0.08-0.21) patients. Telehealth was more commonly available for new patients at National Cancer Institute-designated facilities, medical school-affiliated facilities, and major teaching sites, with high total admissions and below-average timeliness of care. Telehealth availability for established patients was highest at Academic Comprehensive Cancer Programs, nongovernment and nonprofit facilities, medical school-affiliated facilities, Accountable Care Organizations, and facilities with a high number of total admissions. Despite an increase in telehealth services for patients with cancer during the COVID-19 pandemic, we identified differences in access across cancer hospitals, which may relate to measures of clinical volume, affiliation, and infrastructure.

Smart e-Skin Cancer Care in Europe During and after the Covid-19 Pandemic: a Multidisciplinary Expert Consensus.

Melanoma is the deadliest of all the skin cancers and its incidence is increasing every year in Europe. Patients with melanoma often present late to the specialist and treatment is delayed for many reasons (delay in patient consultation, misdiagnosis by general practitioners, and/or limited access to dermatologists). Beyond this, there are significant inequalities in skin cancer between population groups within the same country and between countries across Europe. The emergence of the COVID-19 pandemic only aggravated these health deficiencies. The aim was to create an expert opinion about the challenges in skin cancer management in Europe during the post COVID-19 acute pandemic and to identify and discuss the implementation of new technologies (including e-health and artificial intelligence defined as "Smart Skin Cancer Care") to overcome them. For this purpose, an ad-hoc questionnaire with items addressing topics of skin cancer care was developed, answered independently and discussed by a multidisciplinary European panel of experts comprising dermatologists, dermato-oncologists, patient advocacy representatives, digital health technology experts, and health technology assessment experts. After all panel of experts discussions, a multidisciplinary expert opinion was created. As a conclusion, the access to dermatologists is difficult and will be aggravated in the near future. This fact, together with important differences in Skin Cancer Care in Europe, suggest the need of a new approach to skin health, prevention and disease management paradigm (focused on integration of new technologies) to minimize the impact of skin cancer and to ensure optimal quality and equity.

BT05 Community and Locality Imaging Centres: innovation in the skin cancer care pathway

Abstract Timely management of patients referred with suspected skin cancer remains challenging due to demand that exceeds the capacity of dermatology departments. Encouraging the attachment of images and key metadata along with referrals from primary care helps promote enhanced clinical referral triage. We describe the process of establishing Community and Locality Imaging Centres (CLICs) that seek not only to promote efficient triage, but also to establish a national pipeline of anonymized images, with linked Digital Imaging and Communications in Medicine (DICOM®) data, to assess the potential for future use of artificial intelligence (AI) algorithms in clinical practice. General practitioners (GPs) can request a CLIC appointment at the time of referral, removing the time pressure and potential technical barriers associated with photography and image attachment. Each centre follows the same standardized image capture and hardware operating procedure, ensuring that high-quality, in-focus digital images are consistently acquired. The CLIC appointments take an average of 15 min, during which a suitably trained healthcare professional obtains written patient consent and, using a National Health Service-approved mobile phone with a dermatoscope attachment, takes paired macroscopic and dermoscopic views of each lesion. Relevant metadata, in line with the recently agreed DICOM standards for dermatology, are recorded for individual lesions, enhancing the utility of each photograph. Paired images and metadata are regularly archived to a secure medical image management system and are linked with the referral, allowing dermatologists to perform enhanced clinical triage and communicate one of the following outcomes directly to the referring GP: routine dermatology appointment, urgent dermatology appointment, direct to biopsy or benign lesion–reassurance and discharge. This process aims to streamline the primary care referral pathway and promote immediate benefits to patient care by reducing unnecessary travel for face-to-face outpatient appointments. The establishment of CLICs in Scotland supports referral optimization by providing an efficient, convenient option for GPs and patients to obtain high-quality clinical photography. This model allows for flexible integration into local services: hospital-based with medical photographers, intermediate secondary care-led centres or community-based primary care hubs. Suspected skin cancer referrals can be efficiently triaged by dermatologists when paired with macroscopic and dermoscopic images and relevant patient metadata compliant with DICOM standards. The same images and metadata, once anonymized, can be securely transferred to a nationwide database for deep learning AI algorithm development. Validated AI programs, with the aim of being deployed at the primary care level, inform opportunities for further enhancement of the referral pathway.

Contribution of skin cancer to overall healthcare costs of lung transplantation in Queensland, Australia

Skin cancers are a major source of morbidity in lung transplant recipients, but the relative costs associated with their treatment are unknown. We prospectively followed 90 lung transplant recipients from enrollment in the Skin Tumors in Allograft Recipients study in 2013-2015, until mid-2016. We undertook a cost analysis to quantify the health system costs relating to the index transplant episodeand ongoing costs for 4 years. Linked data from surveys, Australian Medicare claims, and hospital accounting systems were used, and generalized linear models were employed. Median initial hospitalization costs of lung transplantation were AU$115,831 (interquartile range (IQR) $87,428-$177,395). In total, 57 of 90 (63%) participants were treated for skin cancers during follow-up at a total cost of AU$44,038. Among these 57, total government costs per person (mostly of pharmaceuticals) over 4 yearswere median AU$68,489 (IQR $44,682-$113,055) vs AU$59,088 (IQR $38,190-$94,906) among those without skin cancer, with the difference predominantly driven by more doctors' visits, and higher pathology and procedural costs. Healthcare costs overall were also significantly higher in those treated for skin cancers (cost ratio 1.50, 95%CI: 1.09, 2.06) after adjusting for underlying lung disease, age on enrollment, years of immunosuppression, and the number of treated comorbidities. Skin cancer care is a small component of overall costs. While all lung transplant recipients with comorbidities have substantial healthcare costs, those affected by skin cancer incur even greater healthcare costs than those without, highlighting the importance of skin cancer control.

AB116. SOH23ABS_029. Streamlining skin cancer care: the application of lean principles to the non-melanoma skin cancer pathway

AB116. SOH23ABS_029. Streamlining skin cancer care: the application of lean principles to the non-melanoma skin cancer pathway

Financial toxicity and skin cancer care in the US: population-based survey from 2011 to 2018.

This cross-sectional study aimed to examine financial toxicity among people with skin cancer using pooled National Health Interview Survey data from adults in 2011-2018. Material, behavioral, and psychological markers of financial toxicity were compared by lifetime skin cancer history (any melanoma, any skin cancer beside melanoma, and no skin cancer) using multivariable logistic regression models. Of 257,652 total participants, 1874 (0.73%) had known melanoma and 7073 (2.75%) had any skin cancer beside melanoma. History of skin cancers was not independently associated with increased markers of financial toxicity after adjustment for sociodemographic and medical co-morbidities.

Safe and Timely Delivery of Essential Surgical Care for Skin Cancer in a Pandemic

Many surgical practices closed at the onset of the COVID-19 pandemic. We implemented operational changes to safely continue treating patients with cutaneous tumors during the pandemic. This study seeks to evaluate the impact of pandemic-based operational changes on safety, access, and treatment. Here, we report results from a retrospective study from a single academic office-based surgical practice that provided treatment to patients with skin cancer between November 2019 and September 2020. Time to treatment, tumor area, and upstaging after treatment were compared among patients seen “pre-pandemic” (November 2019 to March 2020), during the “pause” (March 2020 to June 2020), and in the “reopening” (June 2020 to September 2020). One-way ANOVA or Fisher Exact analyses were performed, and p &lt; 0.05 was considered significant. Our study included 691 patients (22–101 years old) with a total of 912 tumors. No cases of COVID-19 transmission occurred during the study period. The time from consultation to treatment was reduced during the pause and reopening periods relative to pre-pandemic (p ≤ 0.002), and the average Mohs post-operative defect size remained unchanged throughout the study period (p = 0.75). Consistent with the prioritization of higher-risk tumors in the pandemic peak, a significant reduction in the treatment of basal cell carcinoma tumors was noted during the pause (p = 0.01), and cutaneous squamous cell carcinoma tumors were upstaged more frequently after treatment (p &lt; 0.001). Our findings demonstrate that practice modifications can permit essential surgical care to be delivered safely to patients with high-risk skin cancers during a pandemic.