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Cases have increased annually; a clinician shares his strategy for remaining aggressive and diligent in prevention and management.
The prevalence of skin cancer has risen dramatically to millions of diagnoses annually in the US alone, as ultraviolet (UV) ray exposure and an aging population continues to burden dermatologists with new cases or identified high-risk patients.
For some clinicians, the key strategy is to remain diligent, communicative and aggressive with such patients.
In an interview with HCPLive during the Fall Clinical Dermatology 2023 Conference for PAs & NPs in Orlando, FL, this weekend, Matt Reynolds, PA-C, of Arkansas Dermatology, discussed his blueprint for skin cancer risk detection, prevention, diagnosis and management.
“When you manage high-level, skin cancer patients, I think it’s just vital that you’re following these patients closely,” Reynolds said. “When you have them coming in to your office every 3 or 6 months, doing biopsies and procedures to remove these lesions, I think you need to ask yourself, ‘Am I doing everything I can do for this patient to treat them at the maximum level?’”
For patients with too many lesions, clinicians consider options including topical therapies or systemic treatments including hedgehog inhibitors—a “huge game changer in our practice,” Reynolds said. Clinicians may even refine treatment dosage in their skin cancer encounters; the greater point is to keep considering options in recurring cases.
“Just remember that you need to be assessing risk at every single office appointment,” Reynolds said. “You need to be assessing the overall efficacy of your approach in managing these high-level patients, and remember that there should be another option for these patients besides just surgeries and biopsies at every appointment.”
Reynolds noted the rate of basal cell carcinoma among younger patients is something of a “phenomenon” at practices including his own. Skin cancer prevention education is simplistic but comprehensive for patients. Reynolds stressed measures including the use of SPF 50 or higher sunscreen on their face, trunk and extremities, photo-protective clothing, and general avoidance of sun between 10 AM and 4 PM—all especially for patients with recurring skin cancers.
“You may also consider oral therapy with something like nicotinamide, which is dosed at 500 mg twice a day,” he said. “You can buy it over the counter—there’s a lot of places where you can buy it online…but you should be employing every strategy you can for these patients who continue to develop cancer at a high rate.”
Previous exposure is the key indicator of high skin cancer risk: patients with history of severe sunburn, blistering skin, or those who use tanning beds frequently. Reynolds also stressed the need to monitor older patients on immunosuppressant therapies.
“If we watch them just a little bit closer, if we do manage them a little bit more aggressively, then I feel like we’re doing our due diligence to try and catch these patients that are eventually going to go on to develop a high-level skin cancer in the future.”