A Closer Look at the Skin: The Role of Chiropractors in Early Detection of Skin Cancer
DERMATOLOGY
Hyun S. Kim
DC, FACO
Skin cancer is the most common type of cancer in the United States. More than one million cases are diagnosed each year, and according to current estimates, 40 to 50% of Americans will have skin cancer at least once by the time
they are age 65 ¹. Early diagnosis during the first stages of cancer development leads to a precocious therapeutic strategy with chances of recovery or prolongation of the patient’s life expectancy2.
More people visit primary care physicians (38.2%) than dermatologists (29.9%) for evaluation of suspicious skin lesions3. Some doctors and other healthcare professionals do skin exams as part of routine health check-ups4. Chiropractors are in an ideal position to detect skin cancer because they routinely do inspection and palpation, which is essential to detect any skin lesion or abnormality5.
Common types of skin cancer
The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma, which together account for more than 99% of skin cancers6. Basal cell carcinoma accounts for more than 90% of all skin cancers. Basal cell cancer grows slowly and does not usually spread to other parts of the body. However, if left untreated, it can spread to nearby areas and invade bone and other tissues under the skin. Squamous cell carcinoma is much less common than basal cell carcinoma. It can be more aggressive than basal cell carcinoma and is more likely to grow deep below the skin and spread to distant parts of the body. When squamous or basal cell skin cancers are found early, there is nearly a 100% chance for cure. Malignant melanoma is less common than basal or squamous cell skin cancers, but it is more dangerous and can be deadly. If caught early, there is nearly a 97% chance for cure7.
Early detection and skin self-exams
Most skin cancers can be found early with skin exams. Exams by healthcare professionals and skin self-exams frequently help find cancers early and when they are easier to treat.
Regular skin exams are especially important for people
“Most skin cancers can be found early with skin exams."
who are at higher risk of skin cancer, such as those with reduced immunity, those who have had skin cancer before, or those with a strong family history of skin cancer8.
A useful clinical prediction rule for malignant melanoma is the American Cancer Society’s “ABCDE criteria”3. This system provides an easy way to recognize moles and growths that might be cancerous.
• A is for Asymmetry: One-half of a mole or birthmark does not match the other half
• B is for Border: The edges are irregular, ragged, notched, or blurred.
• C is for Color: The color is not the same all over and may include shades of brown or black, or sometimes patches of pink, red, white, or blue.
• D is for Diameter: The spot is larger than 6 mm across (about a quarter of an inch, or the size of a pencil eraser), although melanomas can sometimes be smaller than this.
• E is for Evolving: The mole is changing in size, shape, or color.
It is important to educate the patient to do a skin self-exam. Examining the skin consists of standing in front of a full-length mirror to visually examine the body for signs of skin cancer and using a handheld mirror to view areas that cannot be seen without a second mirror. It is important to visually inspect the entire body because skin cancer can occur anywhere, not only on areas frequently exposed to the sun9.
A complete annual examination of the skin by a physician supplemented by monthly self-examinations by the patient is recommended for everyone. Patients with a personal or family history of malignant skin cancer should have more frequent examinations by both their physicians and themselves10.
The role of chiropractor in the early detection of skin cancer
Chiropractors need to enhance their ability and training to identify skin cancers for many reasons. First, and most obvious, is the fact that chiropractors see more skin than any other healthcare providers. Most people do not typically examine the skin on their posterior surface, especially over the spine. Even spouses or partners do not typically carefully examine this part of the body, and once children reach the teenage years, their parents are very unlikely to see this region of skin or recognize skin lesions on the back. Considering the increasing incidence of malignant melanoma, the ready access and observation of the skin in chiropractic practice means that chiropractors have a very important role in early detection of skin cancer. Chiropractors must be diligent and refer the patient to another specialist as soon he or she detects any possible skin lesion. Chiropractors must assume the role of primary surveillance5.
Chiropractic education should emphasize the opportunity to detect and assess skin cancer as a routine part of primary prevention, and should correct deficiencies in the training of chiropractic interns where this is needed. This should be taken into consideration by each chiropractic school and assess their interns’ current knowledge regarding detection of skin cancer11.
References:
1. Dummer, R., Pittelkow, M, Iwatsuki, K., Green, A., & Elwan, M. (2011). Skin Cancer: A
World-Wide Perspective. Berlin, Heidelberg: Springer Berlin Heidelberg.
2. Baba, A., & Cdtoi, C. (2007). Comparative Oncology. Bucharest: The Publishing House of the Romanian Academy.
3. Strayer, S., & Reynolds, P. (2003). Diagnosing Skin Malignancy: Assessment of Predictive Clinical Criteria and Risk Factors. The Journal of Family Practice, Mar;52(3):210-8.
4. American Cancer Society: Melanoma Skin Cancer Early Detection, Diagnosis, and Staging. (2016).
5. Wiles, M., Williams,./., & Ahmad, K. (2011). Essentials of Dermatologyfor Chiropractors. Jones and Bartlett publishers, LLC.
6. US Department of Health and Human Services. Office of the Surgeon General: The Surgeon General's Call to Action to Prevent Skin Cancer. (2014).
7. National Cancer Institute: Comprehensive Cancer Information. (2011).
8. American Cancer Society: Skin Cancer Prevention and Early Detection. (2016).
9. American Societyfor Dermatological Surgery: Self Skin Examination Journal. (2010).
10. Friedman, R., Rigel, I)., & Kopf A. Early Detection of Malignant Melanoma: The Role of Physician Examination and Selfexamination of the Skin. CA: A Cancer Journal for Clinicians. May-Jun;35(3): 130-51.
11. Ramcharan, M., Evans, Junior, M. W., Ndetan, H., & Beddard, J. (2011). Knowledge, Perceptions, and Practices of Chiropractic Interns in the Early Detection of Atypical Moles. Journal of Chiropractic Medicine. 10(2), 77-85.
Dr. Hyun S. Kim is a chiropractic physician and a fellow of the Academy of Chiropractic Orthopedist. He is currently working at a federally qualified health center. He can be reached at hkimdc a/mtlook.com
