Q&A: Clinical Pearls in Skin Cancer Awareness for the Community Pharmacist

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For Melanoma and Skin Cancer Awareness Month, Drug Topics sat down with Colleen McCabe, PharmD, BCOP, to glean clinical insights into promoting skin cancer awareness in the community pharmacy.

Skin cancer is a major public health issue in the United States. Diagnoses of the condition outpace diagnoses of all other cancers combined in the country, and with estimates suggesting 1 in 5 Americans will develop some form of skin cancer by age 70, this trend shows no signs of slowing.1,2

There are 2 main types of skin cancer: nonmelanoma and melanoma. Nonmelanoma, further categorized as basal cell carcinoma and squamous cell carcinoma, is the more common of the types, requiring treatment for millions of Americans each year. Melanoma, though less common, is far more aggressive. It arises from pigment-producing melanocytes and has the potential to spread to other parts of the body.

Both types of skin cancer are caused by ultraviolet (UV) radiation exposure, but susceptibility varies across populations. Risk factors such as those associated with skin tone, a history of sunburns (with the risk of melanoma doubling after just 5 burns3), use of tanning beds, and more influence the likelihood of developing the condition.

Luckily, melanoma is highly treatable when caught in its early stages, making awareness and identification of the condition key—2 crucial areas where community pharmacists can significantly contribute through patient education. With their high touch points to patients, community pharmacists play a critical role in ensuring early detection of skin cancer by encouraging skin self-exams, facilitating patient referrals to dermatologists, and providing resources for sun protection.

For Melanoma and Skin Cancer Awareness Month, celebrated annually in May, Drug Topics sat down with Colleen McCabe, PharmD, BCOP, oncology clinical specialist in adult melanoma and sarcoma at Vanderbilt University and Medical Center, to glean clinical insights into promoting skin cancer awareness in the community pharmacy.

READ MORE: Sunscreen Safety: What Every Pharmacist Needs to Know

Drug Topics: Early detection of skin cancer improves treatment outcomes. Can you share any insights on how community pharmacists, through patient interactions, can encourage regular skin self-examinations and follow up with dermatologists if suspicious spots are found?

Colleen McCabe, PharmD, BCOP: I think community pharmacists are really well positioned to make a difference in the community, especially about skin awareness. Oftentimes, patients come up to their community pharmacists asking about different rashes, different conditions with their skin, so I think that is a really great lead way for community pharmacists to create skin awareness about doing those annual self-checks, making sure they are established either with a [primary care provider] or dermatologist in the area, making sure that they are getting those yearly skin examinations, especially if they've had concerning spots in the past.

I think also, as patients are bringing up topical products, being able to open up that conversation too, as well as being familiar with some resources in the area, local dermatologists or local areas that might be able to provide that support [is important].

Drug Topics: Are there specific patient demographics or medical conditions that put individuals at a higher risk for sun damage and skin cancer? How can community pharmacists leverage this information to target sun protection education efforts?

McCabe: Any areas in the country where patients are exposed to more UV radiation [or] more sunlight—so areas of high elevation, areas where you have more direct rays, more of our southern areas, thinking of Florida, and areas like that—would be more at risk. So, pharmacists that are working in those areas [should] just be aware of that to be able to educate their patients.

Patients that have lighter skin tones, especially those that freckle easily or have sort of reddish blond hair, blue eyes, are especially at risk [of] having more sensitive skin to UV radiation. [Pharmacists should consider] occupational hazards, too. If you're working in an area where you have a lot of truck drivers coming through, or pilots—they can still develop some damage through windows. And so, being able to educate patients and being part of your community and understanding the risk factors with your patients.

Drug Topics: While sunscreen is vital, what other sun protection strategies can pharmacists recommend to patients?

McCabe: The biggest risk factor, and the thing that we can educate most on besides just sunscreen, is direct sun exposure in general. So, trying to avoid those sun [rays] between 10am to 4pm, or at least 11am to 2pm, when the sun is really at its highest. I think providing that education along with [the idea that] even if it's overcast outside, you can definitely still have UV exposure, even if you don't feel like you're in direct sun.

Educating on that, along with other things besides sunscreen: hats with a good brim on them, sun-protective clothing that is UV-certified—think of those long sleeve, UV-protected shirts for the beach or the pool. All those would be important along with seeking shade if you're able to [when] sitting out in the middle of the day.

Drug Topics: What strategies can community pharmacists utilize within their pharmacy’s physical space to promote sun safety and sun-protection product selection?

McCabe: I think one of the main ways is having some of those endcap stands by the pharmacist [stocked with] your sun protectives, your sunglasses, your sunscreen. Of course, you want [the endcaps] to be accessible to people coming into the store and leading quickly to provide that, but having a variety of sunscreen that you can educate patients on right at the front there so it's convenient to [them]. While you’re counseling a patient on a medication or filling prescriptions, they're easily able to reference that endcap with those different resources there.

Drug Topics: Is there anything that we didn’t touch on that you wanted to add?

McCabe: The only other thing I would say is that [you should] avoid tanning booths [and] any additional sort of recreational sunbathing—all of that can increase your risk for developing skin cancers down the road.

READ MORE: Dermatology Resource Center

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References
1. Cancer facts and figures 2024. Data sheet. American Cancer Society. Accessed May 14, 2024. https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/
2. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279-282. doi:10.1001/archdermatol.2010.4
3. Pfahlberg A, Kölmel KF, Gefeller O; Febim Study Group. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation- induced melanoma. Br J Dermatol. 2001;144(3):471-475. doi:10.1046/j.1365-2133.2001.04070.x
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