American Academy of Dermatology

Every Monday in May is Melanoma Monday® as part of Skin Cancer Awareness month. Skin cancer awareness is key because one in five Americans will get skin cancer by age 70. Melanoma has a mortality rate of roughly 8,000 individuals each year. Additionally, significant health disparities in detection exist with individuals of lower socioeconomic status and minorities having poorer outcomes.

As a practicing dermatologist for almost two decades, I tell my patients to perform periodic self-exams on their skin to identify skin cancers and I ask if they know what to look for. On the first visit with me, many patients tell me they don’t know all the specifics, they do know to look for changing, strangely colored, funny spots. I show them photos of skin cancer, inserting a handout with the information in their medical chart.

Christine Ko MD

Most often, patients recognize skin cancer once they are emotionally affected because they (or someone they love) have or had a skin cancer. Patients also can have a sixth sense about their own skin, and I trust my patients when they tell me they are worried about a particular lesion. It’s not always skin cancer, but those spots often deserve a biopsy.

In-office medical education for patients is not enough for them to know how skin cancer looks. On average, medical visits are about 15 minutes. Even if I dedicated the entirety of a 15-minute visit to showing my patients how to recognize skin cancer, it’s still not enough time. I don’t expect my medical students or residents to know the nuances of skin cancer — even after a full hour-long lecture.

However, deliberate practice is a lesser-known, yet important, solution for skin cancer recognition. Through deliberate practice on curated images of skin lesions, people can better see skin cancer. YSkin is an example of deliberate practice in action. This free web-based app was developed at Yale and provides exposure to curated photographs of the most common types of skin cancer and skin lesions that are not cancerous. It is centered on the types of skin spots commonly in the U.S. Less than 10 minutes of practice with these photos improved Yale medical students’ ability to recognize skin cancer.

YSkin is based on proven cognitive psychology concepts that promote visual recognition. You can recognize something if you see it, if you get immediate feedback, and if you get to practice, especially if you have a coach. For instance, individuals with no background in art can learn to differentiate artwork by similar artists through a curated session of seeing the artists’ works, guessing the artist, and receiving instant feedback on whether the guess was right or wrong. This is deliberate practice, and it applies to visual perception as well as auditory perception. As memory is enhanced, and if emotions get involved, there is a score in PLAY mode. Increasing scores are associated with positive emotion. In summary, YSkin gamifies skin cancer education.

The American Academy of Dermatology and organizations such as the Skin Cancer Foundation have skin cancer awareness campaigns like The Big See® that emphasize looking at our own skin for potential cancers. The heart of The Big See® are the words NEW, CHANGING, UNUSUAL. The SPOT Skin Cancer™ program SPOT Skin Cancer™ is another skin cancer awareness campaign with a program that includes free skin screenings at various community events.

To be sure, detection of skin cancer is important, but we shouldn’t forget about prevention. Avoid sun exposure when the sun is at its peak, generally between the hours of 10 a.m. and 2 p.m. Wear sunscreen to protect sun exposed skin, cover up whenever possible with sunglasses plus hat or other clothing, and seek shade. Remember that intermittent sunburns are associated with skin cancer. For those who prefer sun exposure to tan, slow and gradual tanning is preferable to intense, intermittent sun exposure that results in burning.

Everyone should self-examine themselves regularly to check for skin cancer. Detecting and being aware of skin cancer is a life-saving technique that should be practiced regularly. Look at your own skin, practice recognizing skin cancer, and know when to be concerned.

Christine J. Ko, MD is a Public Voices Fellow with the OpEd Project and serves as a Professor at Yale University.