Our panel of experts discusses the importance of health literacy and early intervention for skin cancer.
Kishwer S. Nehal, M.D.,
Board-Certified Dermatologist; Board Member, American Society for Dermatologic Surgery
What are some of the most prevalent myths about skin cancer treatments you’ve encountered in your practice, and how have they affected patient decisions?
Prevalent myths about skin cancer include:
- Darker skin types and younger generations are not at risk
- Neither cloudy days nor the winter season requires UV protection
- A base tan from a tanning bed will protect you or is safer than sun exposure
What role does health literacy play in a patient’s ability to discern credible information about skin cancer treatments?
Health literacy is fundamental to patients’ ability to accurately navigate skin cancer diagnosis and treatment. Having a general understanding helps discern credible information on social media. Without a basic foundation of knowledge, patients can easily become overwhelmed, misinterpret information, or fall prey to misinformation from self-proclaimed experts and influencers. It is crucial to understand that there are different types of skin cancer and treatment options. A board-certified dermatologist is the type of physician who has years of training to correctly diagnose and treat conditions of the skin, hair, and nails, including skin cancer. Dermatologists have a responsibility to communicate clearly, provide reliable resources, and answer questions patients may have so that they are active participants in their care.
Do you have any examples of times where misinformation led to delayed diagnosis or treatment? What were the outcomes?
Oftentimes, a delayed diagnosis happens when an individual does not realize a changing mark on the skin could be something more serious. In delicate areas around the eyes, nose, lips, and ears, a skin cancer could appear like a pimple, an irritation from wearing glasses, or even a sore spot from shaving. As a patient, you are the keeper of your skin, so it’s important to have a thorough understanding of your body. Performing monthly self-exams will help you notice when something changes or is a persistent problem area. If you find something you’re unsure of, it’s important to visit your dermatologist. If you don’t have one, you can search for one at asds.net/find.
How can professional skin health organizations help clinicians stay up-to-date on the latest findings and combat misinformation in their practices?
Professional organizations like the American Society for Dermatologic Surgery (ASDS) play a vital role in supporting physicians’ continuing education throughout their careers and proactively combating misinformation:
- ASDS was founded over 50 years ago to promote excellence in patient care through education and research. It offers its members (dermatologic surgeons) a variety of educational activities, including an annual conference with hands-on workshops, procedural courses, mentorship programs, and online learning.
- Publications like the peer-reviewed scientific journal “Dermatologic Surgery” and its accompanying podcast, DermSurgery Digest, keep dermatologists aware of the latest research, techniques, and best practices for dermatologic care, and the Society’s member communications (including emails, social media, and a quarterly magazine) share timely updates on legislative changes, practice affairs, and industry news.
- ASDS combats misinformation by posting medically sound content on its patient-facing ASDS Skin MD social media accounts. All posts are vetted by dermatologists to ensure the messaging is accurate and backed by scientific evidence. The content educates patients on skin health and beauty topics to provide them with a better understanding of dermatologic conditions and treatments.
- Did you know that many states require children to have a prescription or doctor’s note to use sunscreen at school? ASDS and its dermatologist members have helped pass laws to change this in 29 states and Washington, D.C.
- Professional organizations like ASDS also support clinicians by equipping them with free resources to educate their patients and encouraging them to engage in their communities by hosting sun safety events, installing public sunscreen dispensers, and encouraging schools and parks to build sun shade structures on their playgrounds.
Janine Hopkins, M.D., FAAD
Board-Certified Dermatologist, Skin Cancer Specialist, Expert in Image-Guided Superficial Radiation Therapy
What are some of the most prevalent myths about skin cancer treatments you’ve encountered in your practice, and how have they affected patient decisions?
One of the most common myths I encounter is the belief that all skin cancers must be treated surgically. This misconception often leads patients to delay care out of fear of scarring or disfigurement, especially when the lesion is on the face. Many are unaware that non-surgical options like image-guided superficial radiation therapy (IGSRT) offer excellent cure rates with minimal cosmetic impact. Another myth is that basal cell or squamous cell carcinomas are “not serious” and don’t need urgent treatment, which can unfortunately lead to lesion progression and more complex care.
What role does health literacy play in a patient’s ability to discern credible information about skin cancer treatments?
Health literacy is critical. Patients who are not familiar with medical terminology or the nuances of dermatologic treatment often rely on internet searches or anecdotal advice, which may be inaccurate or misleading. As a clinician, I prioritize patient education with thorough discussions using clear, accessible language and visual aids to help patients understand their diagnosis and all available treatment options. This empowers them to make informed, confident decisions about their care.
Do you have any examples of times where misinformation led to delayed diagnosis or treatment? What were the outcomes?
I’ve treated several patients who delayed biopsy or treatment because they believed a lesion “didn’t look like cancer” based on online images, or thought a natural remedy would resolve it. I have also treated several patients who refused surgery due to risks and personal fears. These patients were never offered or educated on non-surgical treatment options. This delay in treatment due to a lack of non-surgical options resulted in advanced, complicated cancers requiring combination and systemic drug therapy. In one case, a patient diagnosed with BCC and given only the option of Mohs surgery, simply grew a mustache to cover the lesion instead of undergoing surgery. After several years, the tumor advanced with bleeding and full thickness of the upper lip, requiring treatment with several months of an oral hedgehog inhibitor, followed by IGSRT for definitive cure. Earlier intervention would have meant a simpler treatment plan. Delays like these can increase morbidity and complicate otherwise manageable cases. For SCC lesions, delay can result in increased risk of tumor spread with metastasis and death.
How can professional skin health organizations help clinicians stay up-to-date on the latest findings and combat misinformation in their practices?
Professional organizations play a vital role by providing evidence-based guidelines and continuing education through peer-reviewed publications. They can also help amplify accurate messaging through public awareness campaigns and support clinicians with tools to educate patients. Encouraging collaboration across specialties and promoting newer modalities like IGSRT ensures we stay at the forefront of skin cancer care and dispel outdated or harmful myths. Educating other physicians on the non-surgical treatment options is an essential part of the education of dermatologists, oncologists, and primary physicians.
Francisca Kartono, D.O., FAOCD, FAAD
Board-Certified Dermatologist; President, American Osteopathic College of Dermatology; Assistant Professor, Michigan State University; Associate Program Director, Corewell Health FH Dermatology Residency Program; Founder, MI Skin Center; Founder, MI Skin Innovations
What are some of the most prevalent myths about skin cancer treatments you’ve encountered in your practice, and how have they affected patient decisions?
Myth 1: “Sunscreens cause skin cancer.” There is no evidence that sunscreen causes skin cancer. There is proof that skin that is sun-damaged is more likely to develop skin cancer. Patients who wear sunscreen are 50% less likely to develop skin cancer than those who do not use sunscreen, and this was proven in several clinical trials. Skin cancer often develops from sun-damaged skin cells that undergo changes due to the radiation from ultraviolet light. Sun rays contain ultraviolet light. Certain ingredients in sunscreen can be irritating to the skin, and some people may be allergic to certain sunscreen ingredients, but they do not cause cancer. Other methods to protect the skin are with sun protective clothing when one is very sensitive to sunscreen molecules, and using mineral sunscreen ingredients over chemical sunscreen ingredients. Broad-spectrum, water-resistant sunscreen with at least SPF 30 should be applied 15 minutes prior to sun exposure and reapplied every 2 hours.
Myth 2: “I don’t need to treat skin cancer since they grow very slowly.” Skin cancers can grow very quickly. Melanomas on the skin can increase in size and depth aggressively and reach lymph nodes within weeks to months. Merkel cell carcinomas can double in size in 2 months. Keratoacanthomas, a type of squamous cell skin cancer, can progress within days and grow from a little bump to a bleeding ulcer within days to weeks. Once skin cancer has spread beyond the skin, the survival rate drops from 95% to as low as 50%. Treat skin cancer early, or it becomes life-threatening.
Myth 3: “I don’t need skin exams because my skin cancer has already been treated.” There is population data showing that if you have had a prior diagnosis of skin cancer, you have a higher likelihood of being diagnosed with another skin cancer. Having had skin cancer means checking in with your dermatologist more often because you are at higher risk for subsequent skin cancer, and your old skin cancer may recur if it behaves aggressively.
What role does health literacy play in a patient’s ability to discern credible information about skin cancer treatments?
There is so much misinformation on the internet when it comes to skin cancer. When health literacy efforts happen in the community, especially with physician-led efforts, such as free skin cancer screenings and spot check campaigns, they are crucial as they can empower the patient with the correct information. This helps those in most need, such as minority groups and at-risk populations (e.g., immunosuppressed patients, elderly patients, pediatric patients).
Do you have any examples of times where misinformation led to delayed diagnosis or treatment? What were the outcomes?
A patient with prior melanoma with lymph node biopsy sees a dermatologist, and when presenting for her visit, she was told they did not take her insurance, and the patient had to leave. A second clinic gave the patient a similar experience. 3 years passed after her melanoma excision, and the patient still did not have a total body skin exam to screen for other skin cancers (the typical recommendation is a skin exam every 6 months for 3 years after a melanoma diagnosis, then annually). The patient finally found our clinic, and I was able to see her. The patient had an insurance plan that misinformed the patient about coverage availability for dermatology. I was only a few miles away from her prior dermatology clinics that rejected her, but it took her 3 years to find me. Her melanoma excision and lymph node biopsy were a costly intervention. We should promote early detection in this scenario to avoid worse outcomes.
How can professional skin health organizations help clinicians stay up-to-date on the latest findings and combat misinformation in their practices?
Many dermatologists are active in community organizations and social community wellness events, and they participate in free melanoma screenings during the month of May for Melanoma Awareness Month.
Professional organizations such as the American Academy of Dermatology (AAD) have made it easier for members to reach media outlets and promote correct information to the public when it comes to skin cancer. The AAD also has handouts and visual cards for distributing to patients in our practices regarding how to perform skin exams, and targeted campaigns to spot melanoma. We can benefit from similar printed media offerings from organizations that explain surgical and non-surgical treatment modalities, and newer approaches for treatments in the elderly, as we live longer lives and are more at risk of developing skin cancers over time.
