The Growing Complexity of Skin Cancer Care

Left to right: Brian Harris, MD, H. Ross Harris, MD, Keith Harris, MD | Image Credit: Harris Dermatology

Fort Myers and Naples, Florida, are distinguished by miles of stunning coastline and hubs for those looking to rest, relax, and retire. Brothers Brian Harris, MD, H. Ross Harris, MD, and Keith Harris, MD, recognized the need for exclusive skin cancer care for predominantly elderly populations and they dedicated their careers to education, detection, Mohs surgery, and more by establishing skin cancer clinics there. In this issue, they are reflecting on the significance of Melanoma and Skin Cancer Awareness Month year-round and share clinical pearls to best serve patients with skin cancer.

“It’s quite a personal relationship we have with this type of cancer,” H. Ross Harris told Dermatology Times. “Multiple family members—our parents and other brothers and sisters in our family—have all experienced [skin cancer]. I think 5 of us have had cutaneous melanoma. When we get to relay how important skin cancer detection and early detection in particular [are] to the public, it’s not only the professional side of us, it’s personal as well.”

Monitoring Comorbidities

Brian Harris discussed the evolution of treatment modalities for skin cancer, particularly focusing on understanding the impact of leukemia and other blood-borne cancers. He noted the increased occurrence of more aggressive tumors associated with certain chemotherapeutic drugs and biological treatments. Brian Harris believes health care providers need to be vigilant in monitoring and addressing these aggressive tumors, particularly in patients undergoing treatment for blood-borne cancers.

Furthermore, Brian Harris emphasized the shift in treatment approaches over the past few years due to the rise of more aggressive tumors. He noted, “What I found in my practice that’s changed or evolved in the last few years is [an] advanced standpoint of now doing more radiation on people after we get them clear with Mohs [surgery].” This change in approach reflects the growing complexity of cancer treatment, with a greater emphasis on multimodal therapies. He stressed the importance of a comprehensive evaluation and individualized treatment planning to ensure optimal outcomes for patients. He also mentioned the use of specialized stains to confirm diagnoses and reassure patients about the chosen treatment path, underscoring the importance of accuracy and patient confidence in the treatment process.

Harris Dermatology prioritizes skin check events year-round and discuss sun safety with a local radio host from WAVV 101.1 FM. Image Credit: Harris Dermatology

Serving the Community

With a patient population of primarily elderly individuals, Harris Dermatology believes it’s important to make patient’s treatment journey as easy and convenient as possible. When patients are treated at Harris Dermatology, their skin cancer concerns are addressed from start to finish by the Harris brothers. Keith Harris completes the initial patient exams. If Keith Harris finds suspicious lesions that require Mohs surgery, he refers patients to Brian and H. Ross Harris. Follow-up appointments will continue to be with the Harris brothers.

“A lot of times people are brought in [by a third party] because they don’t have their own transportation or they rely on their nursing home or some other mode, so to be able to come in and have it all done in one place is very comforting for these patients,” said Keith Harris.

In addition to providing in-depth skin exams and skin cancer treatments in their clinics, the Harris brothers provide yearly free skin cancer screenings at local schools, civic centers, and golf courses to give their community members an introduction to dermatology. To promote their skin cancer screenings and provide skin cancer education, the Harris brothers partner with a local radio broadcaster to answer questions and spread news of their screening events.

“The biggest thing [with skin cancer] is education…. When I have people come in, they often don’t know some details about skin cancer, like where it can occur. Maybe they always think it’s going to be a sun-exposed area. But it’s not always going to be on a sun-exposed area. It can almost be anywhere on the body. So, that’s often news to them, and [that’s] education,” said H. Ross Harris.

Another unique way Harris Dermatology serves its community is by offering free skin cancer screenings to local general practitioners. As Brian Harris pointed out, even physicians want something on their skin to be examined.

Patients Are Living Longer

The Harris brothers realized a skin cancer–only clinic would be beneficial to their community as they saw the patient population living longer, with varying skin cancers still appearing.

“As the patient population ages, we’re seeing skin cancers now in healthy 85-year-olds that we used to see in 65-year-olds. Plus, we’re seeing a lot more cancer because patients are living longer.... We have patients that we have operated on for 30 years,” said Brian Harris.

Skin cancer detection and prevention is crucial in elderly patient populations because there is still time to prevent additional damage, according to the Harris brothers. According to Brian Harris, many of their patients come in thinking that they have already done the worst damage of their life to their skin; however, many patients are going to live 20 to 30 more years and still need to protect themselves from sun damage.

Brian Harris related practicing skin cancer prevention in all stages of life to a cigarette smoker who stops smoking.

“If you smoked for 20 years and stopped and live 40 more years, your risk of lung cancer is probably better if you stopped smoking at 20 years instead of 30 years,” said Brian Harris.

Overall, the Harris brothers agreed that continued skin cancer education is crucial for patients, regardless of their age or experiences with skin cancer.

Standardizing Screening

A crucial factor of skin cancer prevention is routine skin cancer screening. The Harris brothers are passionate about detecting and treating skin cancer because many family members, including themselves, have developed various forms of skin cancer.

Although skin cancer screenings and follow-ups are needed for skin cancer prevention, at what age should individuals start seeing a dermatologist? Brian Harris noted that while there are currently great initiatives in dermatology to bring awareness to multiple disease states as there are in other medical fields, there is no consensus of what age individuals should start regularly seeing a dermatologist.

For example, Brian Harris said that most people know that children need to go to the dentist every 6 months to a year beginning in their early years. He noted that dentists have done a good job at communicating exactly when and how often individuals should see their dentist.

Brian Harris and his brothers concluded that an ideal age for individuals to start seeing a dermatologist is likely in their 20s, especially those who have already had enough sunburns to warrant a skin check. Additionally, Brian Harris noted that dermatology as a specialty will have to come together to form a consensus for patients.

In your opinion, at what age should patients start seeing a dermatologist and why? Email us your thoughts at DTEditor@mmhgroup.com.