More Clinicians are Needed in the Fight Against Skin Cancer

“We need your help. You need to find ways to get some experience because skin cancer is a big problem in the United States. My biggest recommendation would be to find someone close to you, whether they’re in your clinic or a neighboring clinic, that you can just be involved with in these procedures,” said Andrew Baker, MBA, MPAS, PA-C, in an interview with Dermatology Times.

Baker, a board-certified physician assistant at West Ohio Dermatology in Lima, Ohio, and a director at large of the Society of Dermatology Physician Assistants, specializes in inflammatory skin diseases and skin cancer. As May is Melanoma and Skin Cancer Awareness Month, Baker spoke about the importance of early detection and treatment of skin cancer, the need for more advanced practice providers skilled in skin surgeries and Mohs assistance, and the responsibility of clinicians to educate patients and share up-to-date skin cancer information.

At West Ohio Dermatology, Baker spends a large portion of his time completing skin exams for patients with specific concerns or those with a history of skin cancer. Baker also performs skin surgeries 2 days out of the week, with a focus on squamous cell carcinomas, basal cell carcinomas, and melanomas. When a patient needs Mohs surgery for a specific lesion, Baker assists with Mohs closures.

“It’s a really good collaborative approach to make sure our patients get in and out of here at a respectable time,” said Baker.

As a dermatology physician assistant, Baker stressed the importance of more advanced practice providers becoming involved in skin cancer treatments such as skin surgeries and Mohs. Baker’s recommendations for physician assistants interested in learning more skin surgeries and Mohs include:

1. Find a mentor and watch procedures
2. Find a dermatologist or Mohs surgeon that you can work with to complete skin surgeries or Mohs closures

Regarding Melanoma and Skin Cancer Awareness Month, Baker noted that there is always an opportunity for clinicians to improve their skills in skin cancer detection and treatment. Clinicians also have the responsibility of properly educating patients about the risks of skin cancer. Baker is a fan of easy-to-use QR codes that patients can scan in the office and have skin cancer education right at their fingertips.

“Get information for your patients to read. So many patients think that skin cancer can't kill them, it can't hurt them, or it's just some minor problem. But as clinicians, we all know what can happen. And appropriately educating our patients without using scare techniques is very impactful to them and is going to help them throughout their life,” concluded Baker.

Transcript

Andrew Baker, MBA, MPAS, PA-C: Hi, everyone. My name is Andrew Baker, and I'm a dermatology physician assistant located in Ohio. Currently, I work for a private practice, West Ohio Dermatology. Our clinic is primarily a cutaneous oncology skin cancer clinic. We do have a large portion of our practices inflammatory skin diseases well, but the majority of roughly 60% of what we do is skin cancer related.

Dermatology Times: Can you please discuss your specialization in skin cancer detection and Mohs closures in your day-to-day work?

Baker: My first job as a physician assistant was at an academic medical center working in reconstructive plastic surgery. And we worked a lot with dermatologists and surgical oncologists for very complex skin cancer treatment. Over the last 7 years, I've been working in private practice. And as I mentioned, we are a primary skin cancer clinic. So, my role in this is essentially I do lots of skin exams, patients with very specific complaints versus people with a history of skin cancer that are coming in for a skin cancer surveillance exam. That can be done depending on their level of risk and how many skin cancers they've had in their lifetime. Anywhere as frequently every two months, versus 3, 4-, 6-, 9-, or 12-month intervals. During this time period, we do a full head-to-toe skin exam. We have lamps in the room that are just very illuminating to help look at every orifice and surface of our patients. We also use dermoscopy and dermoscopes are a great way to look closer at any other lesion of concern or pigmented lesions that are otherwise unable to be viewed quite as direct.

That is just more of my medical dermatology days. As far as surgical dermatology days go, there are 2 days per week that I strictly do skin surgery and that can mainly encompass squamous cell skin cancer, basal cell skin cancer, and melanoma. So, most of these patients either have a biopsy-proven skin cancer that needs to be re-excised with the appropriate margins of clearance based on current guidelines, or people with very atypical suspicious pigmented lesions that need to have an excisional biopsy for more comprehensive dermatopathology evaluation. Also, kind of peppered throughout the procedural days as well as my medical dermatology skin surveillance days, I do a lot of Mohs closures. We have 2 Mohs surgeons in our office, one of whom is a dermatologist. The other is a plastic surgeon who was Mohs trained, and throughout the day depending on the flow or what their needs are, I can function heavily in this. This means sometimes just doing local numbing for them. Otherwise, sometimes just doing linear side-to-side closures of Mohs defects after they've cleared the cancer, as well as sometimes doing more tissue manipulation, rotation flaps, a lot of times I help with full-thickness skin grafts. It's a really good collaborative approach to make sure our patients get in and out of here at a respectable time, and they're not laying in unfavorable positions for a long time, and ultimately, just helping the flow of our practice.

Dermatology Times: Are there any tools or applications that you recommend for skin cancer detection outside of manual checks?

Baker: Dermoscopy and visual skin exams are what's most common. But there are new innovative ways that clinicians are looking at skin cancer and trying to detect whether or not they need to have a skin biopsy. Truthfully, these are new. We have used some of them, we have used DermTech before which is just sampling some of the genes from the lesion and then looking at the results. And once we get those we can interpret whether or not it needs to have a full-thickness biopsy or not. So that is another option. There are newer options out there that exist that we are currently exploring.

Dermatology Times: What advice do you have for fellow dermatology PAs who may be interested in learning more about skin surgeries and skin cancer treatments?

Baker: Well, the first thing is, we need your help. You need to find ways to get some experience because skin cancer is a big problem in the United States. My biggest recommendation would be to find someone close to you, whether they're in your clinic or a neighboring clinic somewhere, that you can just be involved with in these procedures. And it can just start as just as simply as just watching someone do it. There are so many nuances when you're beginning a new technique, such as skin surgery, that you need to have enough exposure to it that when you're left with a scenario that may not be that straightforward, you have enough of an understanding and comprehensive knowledge, you can figure out what's the most appropriate way to manage whether it's bleeding, or a form of a complex closure. So just watching is number one, and then 2 is doing. Finding a Mohs surgeon that you can ask, "Can I be involved with you? Can I watch you do these procedures? Can I work with you to do the closures?" Many times, Mohs surgeons will initiate the closure by just putting a few strategic stitches in and then allowing a physician assistant to finish the closure, that is very common. And I encourage you to find someone who you can work with. Depending on the level of the Mohs surgeon or dermatologist's experience, there are some PAs that do lots of skin surgery. And then there are some dermatologists who do not do much skin surgery. So, it is just finding what works best for you and what your interests are. And just know that there is definitely a need for your skills.

Dermatology Times: As someone who specializes in skin cancer, what does Melanoma and Skin Cancer Awareness Month mean to you?

Baker: In addition to being involved in skin surgery, and incorporating this into your daily routine, there are a number of resources out there available for you, in person and virtual to learn to be better at what you're doing. This is a great opportunity to put these out more on social media and other platforms to allow people to know that these exist. So, number one, skin cancer awareness for clinicians, we need to get better at what we do, better at detection, and better at treatment. And that comes in all forms. A lot of that is looking for these resources on your own and being your own advocate to get the skills and develop them over time. So, you can help your patients. So that's number one. Number 2, we have lots of brochures around our office and posters that have QR codes during melanoma skin cancer awareness month. It's just another opportunity to put out a little bit more of that information. When your patients are sitting in a room waiting to be seen, there's more information for them to educate themselves on: what's the importance of self-skin exams, sun protection, routine skin checks; these are all really important things that frankly, a lot of people do not use and do not understand. So as far as an office, I believe it's just a good opportunity to put more information out there for our patients. I love QR codes, I think they're really quick and easy. They've seemed to be really impactful for our patient population.

Lastly, I would say, it gives you another opportunity to talk to your patients. And this can be on either spectrum, it can be from a new patient who comes in because they have concerns over a lesion that has no history of skin cancer. It's an opportunity to really have a discussion with them about the known causes of skin cancer and what they can do to prevent it. As well as the other side of the spectrum, about people who have had lots of skin cancer. Depending on whether this is squamous cell carcinoma, or melanoma, both of these skin cancers can metastasize and spread. You don't want to be intimidating and trying to use a scare tactic for your patients, but just finding creative ways to let them know the true risk and the need for appropriate skin exams and need for certain treatments to ensure that these cancers do not spread.

Dermatology Times: Have you noticed any different skin cancer trends among different patient populations or ages?

Baker: That's a harder one. I think anecdotally, people regardless of your demographic, or what type of practice setting you're in, we all have suspicions about things that can be causing skin cancer to become more prevalent and prominent, some of which is diet. There are lots of technological advances that have unknown amounts of radiation that we're all being exposed to. So, those are certainly things that there needs to be much more research on to better understand. And there's no clear-cut answer on that. But what we do know is that the aging population is getting to the age where skin cancer is most common. And there's more of these individuals at this age. So, regardless of personal and political beliefs, we know that the aging population who did not protect themselves from the sun, has the highest risk for skin cancer at this time, and we absolutely see this increasing. Hopefully, with some of the trend changes such as realizing that tanning bed use does cause skin cancer and melanoma, as well as some of the bans for tanning bed use for minors, when these things become more common, we can help decrease the amount of skin cancer over time.

Dermatology Times: Do you have any closing thoughts on Melanoma and Skin Cancer Awareness Month?

Baker: Use this to make yourself better. Life is busy. Most of us have families, we have all these other moving parts in our lives. Take this opportunity to educate yourself on a new technique or a new skill. Or look at the pipeline that's coming for skin cancer treatment or skin cancer detection. It's a really great opportunity to help better educate yourself and know what else is out there, so you can provide the best individualized treatment plan for your patients. Shared decision-making is so important, so if you're providing your patient with all the most appropriate options for treatment, or diagnosis of their skin cancer, put them into the equation and make sure that you're doing what's best for them. The last thing I would say is to get information for your patients to read. So many patients think that skin cancer can't kill them. It can't hurt them. It's just some minor problem. But as clinicians, we all know what can happen. Appropriately educating our patients without using scare techniques is very impactful to them and is going to help them throughout their life.

[Transcript lightly edited for space and clarity.]