It is crucial for dermatologists to ensure patients are well-informed about available treatment options.
As dermatologists, we are faced with a well-known, yet growing, skin cancer epidemic: more than 5 million cases of skin cancer are diagnosed in the United States each year, making it the most common type of cancer.1 Furthermore, practicing in Boca Raton, Florida, with an older patient population, I especially see this unfortunate trend continuing its uptick daily. Not only are we seeing greater incidence of skin cancers, but they are also trending toward larger sizes at the time of diagnosis.
At the same time, even though the incidence of skin cancer is increasing, people are also experiencing improved longevity. Patients are eating healthier, exercising more, and making better lifestyle decisions, thus enjoying longer, more fulfilled lives. As patients live longer, though, they often have multiple complex medical comorbidities that impact our choices for treating skin cancer. Increasingly complex medical histories require a variety of therapeutic treatment options in addressing patients’ skin cancers.
Dermatologists are the experts in skin cancer diagnosis and treatment, and as such, it is critical that we remain at the frontlines of innovation and have the ability to discuss all of the different treatment options available with our patients. We must tailor treatments to best accommodate patients’ specific situations and always be on the lookout for—and open to—new, innovative tools to aid in treating patients.
We cannot assume that one treatment is the automatic solution for everyone, as each patient’s situation is unique. It is this skill in diagnosis and treatment selection that enables dermatologists to have high cure rates, high patient satisfaction, and optimized clinical and aesthetic outcomes. It also allows dermatologists to effectively and safely treat skin cancer in a cost-efficient way, which becomes increasingly important as we move into alternative payment models for health care delivery.
While surgery is often considered the first-line treatment for skin cancer, it is important to remember that it may not be right for all patients, especially for those whom surgery can be particularly high risk. When reviewing patients’ skin cancer diagnoses with them, as part of our initial discussion, I thoroughly go through patients’ medical histories and identify all of the risks of surgery. Risks can include comorbid medical conditions—diabetes, anticoagulation therapy, and heart disease that can complicate cutaneous surgery—and medications like blood thinners, steroids, and immunosuppressants.
Additionally, during these conversations, the topic of lifestyle often comes up; while downtime is undoubtedly important, for the most part, people do not want interruptions to their daily lives. They want to continue working, traveling, and playing with their grandchildren, and they will do whatever it takes to maintain their current quality of life.
When the time comes to go through treatment types, I lay out all of the relevant options and provide my recommendation. Treatments can include topical chemotherapy creams (where appropriate), electrodesiccation and curettage, traditional excision, Mohs micrographic surgery, and superficial radiation therapy, which is a nonsurgical treatment option (Table). We cover the risks and benefits of each, plus alternatives where available. All of this is vital to ensuring that patients are well-informed and empowered to choose the treatment option that is best for them. This is our duty as dermatologists.
Thus, given the ongoing high rate of skin cancer, it is our collective responsibility to make sure that we have every available tool in our toolbox to help our patients live the best life possible.
Dr Fromowitz is a board-certified dermatologist and has completed advanced training in Mohs micrographic surgery and cosmetic dermatology. Practicing in Boca Raton, Florida, Dr Fromowitz serves as the medical director of Dermatology of Boca.
Disclosure: Dr Fromowitz has been paid an honorarium by Sensus Healthcare for educating doctors and patients about the SRT technology.
1. Key statistics for basal and squamous cell skin cancers. American Cancer Society. https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/key-statistics.html. Updated. January 4, 2018.