As the baby boomers reach retirement age,
the United States is beginning to experience the worldwide skin cancer epidemic. The most common skin cancers are basal cell carcinomas, followed by squamous cell carcinomas and, finally, melanoma. While obvious signs of advanced skin cancers include bleeding and rapid growth, distinguishing a benign skin growth versus an early malignant skin growth is often difficult. The chart to the right illustrates this point. On a busy clinic day, how confident would any of us be in our ability to distinguish the three malignant lesions from the five common benign ones seen in this chart?
Studies have shown that even experienced clinicians can miss diagnosing early skin cancer. In one study, dermatologists failed to recognize melanoma 26% of the time, and non-dermatologists fared even worse. The bottom line: to diagnose more skin cancers at an earlier stage, one must do more skin biopsies. A skin biopsy followed by an accurate pathology report is the only way to be absolutely sure that a suspicious lesion is benign. One of the most common reasons for malpractice suits is the failure to diagnose cancer. An early and adequate biopsy can diagnose early stage disease or provide reassurance for concerned patients.
Unfortunately, a thorough skin exam with a biopsy is increasingly difficult for busy physicians to accommodate. A suspicious skin lesion can seem like the least of a patient's complicated medical problems. Biopsying every skin abnormality is impractical. So, when is it appropriate to biopsy?