Screening and Intervention for Skin Cancer in the Galapagos
Marissa Ayasse, BS1, Jocellie Marquez, MD, MBA1, Daniel Lozeau, MD2, Jordan Slutsky, MD2, Tara Kaufmann, MD2, Yoojin Lee, MD2, Richard J. Scriven, MD2, Alexander B. Dagum, MD3.
1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA, 2Stony Brook University Hospital, Stony Brook, NY, USA, 3Division of Plastic and Reconstructive Surgery at Stony Brook University Hospital, Stony Brook, NY, USA.
Lack of histological assessment remains a major limitation of the American Academy of Dermatology’s (AAD) national SPOTme screening program. This study correlates presumptive screening skin cancer diagnoses with histological confirmation among a highly sun-exposed population with limited access to care as well as differences between patients with skin cancer versus those without.
An IRB approved prospective study was performed at the Blanca’s House free clinic, a non-profit surgical volunteer organization, in the Galapagos Islands. After consent, a 40-item modified SPOTme-inspired questionnaire was completed. Partial or total body skin examinations (TBSE) were conducted by board-certified dermatologists. Board-certified plastic and general surgeons performed excisional biopsies on suspicious lesions. Children (<18 years) and non-Spanish or non-English speakers were excluded.
Two hundred and seventy-three patients were included: 140 males (51.3%) and 133 females (48.7%). Mean age was 40.95 years. TBSE was performed on 69.2% while partial examinations on 30.8%. A total of 12 patients (4.4%) had presumptive skin cancer after questionnaire and clinical screen. Six (2.19%) biopsies confirmed skin cancer histologically (Group 1), 2 biopsies were benign, 2 refused the procedure and 2 demonstrated advanced disease unable to be excised. Seven basal cell carcinomas (BCC), 1 squamous cell carcinoma (SCC), and 1 melanoma in situ were identified. All BCC and SCC lesions demonstrated clear margins. Melanoma in situ, located on the right lower eyelid, was subsequently treated in the United States where invasive melanoma with a Breslow thickness of 0.3mm was found.
Compared to the non-cancer group (Group 2: n = 265), Group 1 had significantly higher likelihood of reporting having seen a dermatologist (83% vs 37%, p=0.02), taken any medications (66% vs 12%, p=0.0001), having blonde or red hair (33% vs 6%, p=0.01), blue or green eyes (66% vs 9%, p<0.0001) and having used indoor tanning equipment (16% vs 0%, p<0.0001). Group 1 was also more likely to report 4 or more blistering sunburns (60% vs. 26%, p=0.08) which approached significance. When evaluated by dermatologists, Group 1 was significantly more likely to be classified as “high risk” for developing cancerous lesion (100% vs. 1%, p<0.0001) compared to Group 2.
Conclusion: This modified SPOTme-inspired skin cancer screening questionnaire with dermatological examination is an accurate screening tool. We were able to confirm this with excisional biopsy and histological analysis. Skin cancer screening can be useful in detecting skin cancer in vulnerable international communities that would have otherwise experienced delays in diagnosis.
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