The Importance of Early Recognition of Skin Cancer

Aaron S. Farberg, MD, Editor

Darrell S. Rigel, MD, MS, Editor

Skin cancer is the most commonly diagnosed malignancy, with its annual incidence greater than that of all other forms of human malignancy combined. Nearly 5 million people are treated annually in the United States for skin cancer, with an estimated cost of over 8 billion dollars per year. Over 150,000 of those people are diagnosed with melanoma, the deadliest form of skin cancer, each year. Although a massive public health initiative is underway to help educate patients and limit future diagnosis of skin cancer through primary prevention, the value of the early diagnosis and management of skin cancer cannot be understated. It has the potential to be lifesaving, by giving the physician the opportunity to cure most malignancies with prompt surgical excision. Unfortunately, not all skin cancers are diagnosed early before they affect quality of life and become disfiguring or potentially lethal.

The diagnosis of both non-melanoma skin cancer and melanoma has traditionally been made by inspection and biopsy of suspicious lesions with subsequent histological examination. Clinical diagnosis of melanoma has evolved significantly in the past 40 years. Prior to 1985, melanoma was rarely diagnosed before gross clinical features were present. In 1985, in a joint national program from the American Academy of Dermatology and the American Cancer Society, the ABCD criteria were introduced, which taught many of the features of early melanoma to physicians and the general public. This initiated a massive education and public health campaign that has aided in the earlier diagnosis of melanoma. Despite patient education efforts and prophylactic screening, all forms of skin cancer are still being diagnosed, even at late stages, at alarming rates. The goal for all clinicians should be to strive to increase their ability to detect skin cancer early when it can be effectively treated.

Timely diagnosis of cutaneous malignancy is critical in reducing morbidity, mortality, and the increased health care costs associated with treatment of advanced disease. Despite increasing incidences of all types of skin cancers, detection is now happening earlier before disease becomes disfiguring or advanced. The cornerstone of diagnosis for skin cancers largely remains clinical and continues to evolve with improved recognition and description of common malignant features. Despite advances, unaided visual examination of the skin alone may still be suboptimal in screening for skin cancer. In order to continue to improve early detection and outcomes, the development of accurate, sensitive, and objective diagnostic instruments to help aid the visual diagnosis is important. Technologies are emerging to aid in biopsy decisions, specimen evaluation, and risk stratification, which have the potential to have a tremendous impact on public health and patient outcomes.

This issue of Dermatologic Clinics provides a comprehensive overview of the current state of skin cancer diagnosis, the new and emerging technologies within the field, and their integration into daily clinical practice. It is hoped the information presented here will help the readers improve their knowledge related to these issues, helping to reach the goals of attaining earlier detection, decreasing the number of unnecessary biopsies, improving diagnostic and prognostic accuracy, and reducing costs to both patients and the health care system.

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