Telehealth Helps Doctors Catch Skin Cancers as Screenings Plummet

The goal is “to weigh the risks against the benefits,” explains Cerrene Giordano, a dermatologic surgeon and assistant professor of clinical dermatology at the University of Pennsylvania's Perelman School of Medicine. “Leaving some of these skin cancers such as melanoma untreated, especially if they are at a more aggressive stage, could potentially be more life-threatening than the risk of COVID-19,” she adds.

Even with some doctor's offices and clinics resuming in-person appointments, cancer screening rates for 2020 are far behind where they should be. A report from the health care technology company Komodo Health found that colonoscopies and biopsies performed to diagnose colon cancer declined by nearly 90 percent between January and mid-April, compared to the same period last year; cervical cancer screenings were down by more than 68 percent.

"We looked at all of our biopsy results from March 14, which is when all our clinics closed down, through the end of April and they all just plummeted,” says Carrie Kovarik, a dermatopathologist and associate professor of dermatology at the University of Pennsylvania's Perelman School of Medicine. “And it was really shocking to see how few melanomas and non-melanoma skin cancers we were diagnosing when we know that they're still out there.”

Dermatology, however, has an advantage over other specialties when it comes to detecting a potential cancer. It's a “visual field,” explains Julie Karen, a New York City-based dermatologist and clinical assistant professor of dermatology at New York University Grossman School of Medicine. And high-tech imaging equipment and invasive procedures are not always needed to let doctors know that there's cause for concern.

"There are things that we look at by telemedicine and say, ‘That's definitely cancer.’ You know, some things you can still tell,” Kovarik says.

Causes for concern

Even still, tele-dermatology has its limitations. Full body skin exams, which doctors regularly perform during in-office visits to identify suspicious spots, are not conducive to video appointments and phone calls. Instead, dermatologists are asking patients to do their own skin checks at home and to reach out with any concerns — at least until normal appointment loads resume.

When going over your skin, keep the children's story “The Ugly Duckling” in mind, Giordano says. “People tend to have spots that look the same on their body, and so if they have a spot that all of a sudden doesn't quite look like the other spots, or doesn't quite fit in,” it could be a warning sign of cancer, she explains.

Dermatologists also use the first five letters of the alphabet — ABCDE — as a guide to help people recognize a melanoma, with A standing for Asymmetrical; B standing for uneven Borders; C standing for multiple Colors; D standing for Diameter (it's a warning sign if the size of the spot in question is larger than a pencil eraser — about 1/4 inch); and E standing for a spot that is Evolving.

If you notice a marking on your skin that fits this criteria, contact your doctor right away. Other warning signs that warrant a call to a dermatologist include itching, pain or bleeding on the spot in question. Finally: Don't neglect proper sun protection this summer. Wear sunscreen and reapply it often, Giordano says. And seek out shade during the sunniest points of the day.

Looking at his hand now, Knox says he can hardly tell a nickel-sized skin cancer was removed just a few months ago. The whole ordeal was the first time he used telehealth, but it won't be the last. Knox has already rescheduled upcoming in-person medical appointments to online visits.

"It saves me a trip,” he says. When you go into the office, “they make you sit around for a half an hour, 45 minutes. If you do telemedicine, at least you're at home, getting things done,” he adds.