Every year more people are diagnosed with skin cancer in the United States than all other cancers combined. (1)This results in one in five Americans having developed skin cancer by the age of 70. (2) Most skin cancers are treatable when found early; therefore, as dental hygienists, we have the ability to identify suspicious lesions for referral.
Educating our patients
Each time I see a patient for the first time, I inquire about his or her experience at the dermatologist. Often, patients are shocked that I am asking about their skin. This creates an opportunity to educate patients on the head and neck examination dental hygienists provide and how our goal for patients is prevention of disease throughout their entire body, not just the mouth.
I then ask the patient how often he or she is in the sun and if he or she has had an area of concern removed before. I reinforce the need for yearly consultations with a dermatologist. Not only will this help us identify skin cancer earlier, it could save the lives of our patients.
Understand the “ABCs” of melanomas or other skin cancers
According to the Mankato Clinic, the “ABCs” of skin cancers are as follows:
"A – Asymmetrical shape: Look for moles that are irregular in shape, with two different halves.
B – Irregular border: Look for moles with notched, scalloped, or irregular moles.
C – Changes in color: Look for growths that have an uneven distribution of color.
D – Diameter: Look for new growth in a mole larger than a 1/4 inch.
E – Evolving: Look for changes over time, such as a mole that changes in color or shape, or increases in size. Moles can also change and develop new signs and symptoms, and may bleed or itch." (3)
Measure, photograph, document, and refer
When an area appears to have one or more of the ABCs, a referral to a dermatologist should be given. Measuring the height and width is important to be able to have a baseline of information.
A photograph should be taken of the lesion to determine if any changes take place between visits. The color, size, texture, shape, and border should be listed in the patient chart for proper future assessment. All information should be included in the referral to the dermatologist to assist the doctor in diagnosing the patient.
Patients who have been exposed to UV light from the sun or tanning beds are at higher risk for skin damage and skin cancers. The UV rays can damage the DNA of the skin cells and affect the DNA of genes that control the skin cell growth.
Therefore, it is important to advise patients to wear proper protection such as hats, sunglasses, and sunscreen when exposed to the sun. (1) Men are more likely to have basal and squamous cell cancers. The most common place for a man to have skin cancer is the left ear, often thought to be linked to the exposure to the sun while driving and increased outdoor activities. (1) Patients with compromised immune systems, patients who smoke, and those treated for skin conditions should also be considered higher risk. (1)
The unique role of preventive-centric care allows dental hygienists to thrive in their ability to prevent the progression of disease, and aid in detecting disease in its earliest stages. The increase of skin cancer creates additional urgency for thorough head and neck examinations of all patients. It is never too early to document and refer—it could save a life!
1. Cancer Facts and Figures 2018. American Cancer Society website. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf. Published 2018. Accessed June 13, 2018.
2. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279-82. doi: 10.1001/archdermatol.2010.4.
3. May is Melanoma Awareness Month. Mankato Clinic website. http://www.mankatoclinic.com/may-is-melanoma-awareness-month. Published May 5, 2017. Accessed June 13, 2018.
Editor's note: This article first appeared in RDH eVillage. Click here to subscribe.
Amber Auger, RDH, MPH, is a hygienist with experience in multiple clinical settings, including facilities abroad. Amber obtained a master’s degree in public health from the University of New England and a bachelor’s in dental hygiene from the University of New Haven. She holds a part-time position at an elite dental office in Boston. Amber Auger is a key opinion leader for several dental companies, speaker and published author, and can be contacted at amberaugerrdh.com.