Skin Cancer Knowledge Suboptimal Among Patients

Adult patients from dermatology clinics affiliated with 2 Midwest universities were evaluated for their ability to differentiate skin cancer by sight and for their skin cancer knowledge.

Early detection and treatment of skin cancer are known to reduce morbidity and mortality from the disease, as is a history of melanoma or nonmelanoma skin cancer to increase the risk of subsequent cancers, according to the authors of a new study published in International Journal of Women’s Dermatology. However, their findings from evaluations conducted among 244 adult patients show persistent gaps in patients’ skin cancer knowledge and they are calling for enhanced education in the space.

“Education targeted to patients’ needs would be optimal; however, such targeting is difficult without knowing patients’ levels of knowledge regarding skin cancer,” the study authors wrote. “However, to our knowledge, no survey-based studies utilizing photographs of skin lesions have been done in the patient population in the United States.”

Patients (57% female; mean [SD] age, 61 [15] years) were surveyed who received care at the outpatient dermatology clinics affiliated with the University of Oklahoma (n = 100) and Loyola University Chicago (n = 144), with individuals aged 40 to 90 years asked to participate in a survey at the end of their clinic visit and to view and identify 12 digital images of benign and malignant skin lesions. Retrospective chart reviews confirmed patients’ biopsy-proven skin cancer history.

Forty percent had a family history of skin cancer, and 43%, a personal history of the disease. Seventy-two percent reported not using daily sunscreen when outside, and among those who reported on their sunscreen use frequency, the most common response was “sometimes” in 39%. Sixteen percent reported never using sunscreen. These results were seen despite 95% reporting they knew regular sunscreen use helps prevent skin cancer.

Higher knowledge scores—based on sum of correct responses to the digital images—had a positive correlation with family history of skin cancer vs not having that history (P = .02) but not with a personal history (P = .47).

A negative correlation was seen between age and correctly guessing about lesions, with each year of older age corresponding to a 0.02-point decrease in total knowledge score (P = .01). Overall scores between female and male participants did not significantly differ, the authors noted, and most could correctly guess malignant lesions.

Benign lesions proved difficult to decipher, with seborrheic keratoses and cherry angiomas misidentified as malignant most often, with total correct scores of 26% and 31%, respectively. In contrast, melanoma and squamous cell were most often correctly identified, with rates of 93% and 86%, respectively.

A question was also asked about Fitzpatrick skin type, but scores did not differ according to the types patients reported having, with influence scores ranging from 7.71 with type V to 8.14 with type II.

“The findings in this study demonstrate that there is a gap in knowledge within the dermatology clinic patient population regarding the recognition of benign and malignant skin lesions,” the authors concluded. “While patients may be familiar with some of the signs and symptoms of skin cancer, it is important for dermatologists to educate patients that not all skin cancers exhibit characteristics that conform to ABCDE [asymmetry, border, color, diameter, evolution] or other checklist features.”

In addition, this education should be frequent among patients who have a skin cancer history, and sunscreen use should be encouraged whenever outdoors.

Reference

Lee K, Nguyen N, Fuzzell M, et al.Assessing individual patients’ knowledge of benign versus malignant skin lesions in the dermatology clinic population. Int J Womens Dermatol. Published online July 25, 2022. doi:10.1097/JW9.0000000000000032