Horizon Medical Services

When it comes to skin cancer treatment, patients have many options – from surgery to topical chemotherapy to radiation. But in South Florida, there is only one treatment option that no other state has, and it comes directly to its patients: It’s called Horizon Medical Services.

Our doctors make house calls and that’s what sets us apart from anyone else nationwide and worldwide.

Our treatment vehicles are state-of-the-art mobile radiation therapy offices where expert radiation oncologists along with their highly trained staff go to patients’ homes, wherever they live in South Florida to treat their skin cancer.

We treat patients across South Florida from Miami-Dade, Broward, and the Palm Beaches.

“I would certainly recommend it,” says Ben Pumpian, a Horizon patient who had the option of going to a cancer treatment center for his skin cancer but chose Horizon instead. “It’s so easy, you just sit in your home and when the truck arrives, you get into it, get treated and in about half an hour you’re back inside your home going about your business. It’s fantastic and I’m very satisfied with the treatment results.”
Ben calls Horizon’s treatments easy and painless.

Skin Cancer Treatment Miami
While skin cancer patients often have a variety of treatment options – including surgery, which can be painful and disfiguring — one of the most highly-effective options is high-dose radiation (HDR), which is an alternative to surgery. Don’t let the word radiation scare you.

HDR therapy offered by Horizon Medical Services is effective and can spare healthy tissue surrounding the cancer site.
The treatment is also painless.
Patients say there is little downtime and that they feel tired after treatment, but after a short nap are ready to go get up and go. Patients also love it because it avoids the risks that come with surgery, like bleeding and scars.

For patients with skin cancer in conspicuous or sensitive places like their faces, noses, neck, or arms — walking away from any treatment cancer free and with minimal to no disfigurement are priorities. At Horizon, we know that.

Dr. Pomper on Skin Cancer Treatment
“The beauty of what we do is we can actually go to the patient’s home and do the treatments. Therefore, patients have the best of all worlds. They can get the treatments, have minimal, if any side effects, a good cure rate, without even having to go to a cancer center,” says Dr. Mark Pomper, a board-certified radiation oncologist and medical director of Horizon Medical Services.

Radiation for skin cancer offers a 95% cure rate for basal and squamous cell carcinomas, according to one 10-year study.

And the Journal of Clinical and Aesthetic Dermatology reports that superficial radiation therapy should be the first option for certain types of skin cancer because cure rates are similar to surgical options.

According to the American Cancer Society, HDR can also be used for early stage melanomas as an alternative to surgery.
“Often times the look after such a major facial surgery doesn’t turn out well, even with cosmetic surgery, but we can very likely cure your cancer non-invasively with about 16 radiation therapy treatments, and no scarring,” Dr. Pomper says.

“I tell everyone I can about Horizon Medical Services. Who knew doctors still make house calls? No one can believe it when I tell them. Everyone should know about this convenient service,” says Carmen, a Horizon patient who chose HDR over surgery for a large cancer on her lip.
She is now cancer free.

The length and type of HDR treatment depends on the stage and type of a patient’s skin cancer as well as the location. Each session is usually less than 30 minutes.
To book an appointment, learn how radiation can treat your skin cancer or learn more about our mobile radiation treatment services, call us at (954)-730-2333.
Horizon Medical Services


https://tinyurl.com/49dkmxxs

What Sets Our Skin Cancer Treatment in Miami Apart | HSM In South Florida, there is only one treatment option that no other state has, and it comes directly to its patients for skin cancer treatment.

If you’re looking to get rid of an unsightly or painful keloid for good, South Florida’s own Horizon Medical Services may just have the right treatment for you.
First let’s start with the basics. What is a keloid?
It’s a benign, harmless raised scar that can be brought on by anything including acne, burns, scratches and even marks from injection sites. Keloids tend to be more common in individuals under the age of 30, those with deeper skin tones and those with a family history of keloids. If it’s on a joint like an elbow or knee, it can make movement hard or painful. They’re often not attractive and without the right treatment, they can recur.

Keloid Removal Miami
Removing keloids and saying goodbye for good is a multi-step process, which may seem daunting at first, but it’s worth it in the long run.

According to the Mayo Clinic, the keloid has to be removed first with one of several treatment options including:
• Freezing the scar or cryotherapy: Doctors may freeze off smaller keloids with liquid nitrogen.
• Laser therapy: Larger keloids can be treated with pulsed-dye laser. The therapy takes several sessions with four to eight weeks between each treatment.
• Surgery: Surgery may also be an option. But keep in mind surgery can be combined with other treatments. With surgery alone, recurrence rates are between 45 and 100 percent.

Then after the keloid is removed, patients can turn to radiation to make sure it doesn’t return. Think of it as a one-two punch.

That’s where Horizon Medical Services can help.
Don’t let the word radiation scare you from treating your keloid with radiation.

Superficial radiation therapy or high-dose radiation (HDR) — like that offered by Horizon Medical Services — following surgery offers a 95% success rate to help say goodbye to a keloid for good, according to Dr. Mark Pomper, Horizon’s founder, and board-certified radiation oncologist.
“High dose radiation targets cells that cause abnormal scar tissue growth. The scar tissue must first be removed by your dermatologist, plastic surgeon, or general surgeon. Then within 24 hours of removal, the area should be treated with HDR, which reduces the production of abnormal collagen and prevents the keloid from returning,” Dr. Pomper says.

According to one study, surgery followed by radiation may be the most effective treatment for keloids. With HDR for keloids, there are no significant side effects, no pain and no discomfort. Most patients need two to three treatments.

Mobile Radiation Therapy for Keloids and Skin Cancer
When patients choose Horizon, they don’t have to travel to the doctor’s office for treatment, the treatment comes to them.
Horizon has vehicles specially equipped with the latest radiation technology, which travel to patients in Miami-Dade, Monroe, Broward, and Palm Beach Counties.

Patients are treated inside the vans under the supervision of trained physicians and experts.
Not only does Horizon’s HDR treat keloids, but it can also treat skin cancer too. In fact, radiation has been used to treat skin cancer for a century.

HDR is used to treat basal cell carcinomas, squamous cell carcinomas and some melanomas. It’s safe, effective and spares healthy tissue surrounding the cancer site.

There is also little to no downtime. Some patients say they are a little fatigued after treatment but feel it’s well worth it since they avoid the risks that come with surgery.

To learn more about our mobile radiation therapy services for keloids or skin cancer, call Horizon Medical Services at (954) 730-2333

https://tinyurl.com/bdhszprt

Say Goodbye For Good: Keloid Removal Miami | HMS If you’re looking to get rid of an unsightly or painful keloid for good, South Florida’s own Horizon Medical has the right treatment for you.

Do You Have Blue Eyes? While it’s a very rare type of cancer, people with blue eyes are at higher risk of developing ocular uveal melanoma. Plus, although this cancer is extremely rare, light-eyed folks are also more susceptible to sun damage from exposure to UV rays and skin cancer.

So keep in mind, if you want to protect and preserve those baby blues, you need to keep up with routine eye exams and at the same time protect your skin and have full body skin exams annually.

About half as many Americans have blue eyes as brown eyes. Worldwide, fewer than 9% of people have blue eyes. Blue eyes aren’t even actually blue. Rather than including a blue pigment, they actually just lack the pigment that makes eyes brown.

1. Everyone with blue eyes is related
Between 6,000 and 10,000 years ago, a baby was born in Europe with a harmless genetic mutation. That little DNA blip was blue eye color, according to researchers at the University of Copenhagen.
As far as researchers can tell, this was the first person with blue eyes, and everyone who has blue eyes today is a (very) distant relative of this ancient human.
“Originally, we all had brown eyes,” said Hans Eiberg, associate professor in the Department of Cellular and Molecular Medicine at the university.
“But a genetic mutation affecting the OCA2 gene in our chromosomes resulted in the creation of a ‘switch,’ which literally turned off the ability to produce brown eyes.”
Eye color depends on how much of a pigment called melanin lives in the iris of the eye. Melanin is also responsible for the color of our skin, eyes and hair.
This genetic switch limits how much melanin is produced in the iris — effectively “diluting” brown eyes to a shade of blue.
In addition to having significantly less melanin in their iris than people with brown eyes, hazel eyes or green eyes, blue-eyed individuals don’t have very much variation in the part of their DNA responsible for melanin production.
Brown-eyed individuals, on the other hand, have a lot more variation.
“From this we can conclude that all blue-eyed individuals are linked to the same ancestor,” said Eiberg. “They have all inherited the same switch at exactly the same spot in their DNA.”

2. Blue eyes aren’t actually blue
Blue eye color is determined by melanin, and melanin is actually brown by nature.
The color of our eyes depends on how much melanin is present in the iris. Brown eyes have the highest amount of melanin in the iris, and blue eyes have the least.
Brown melanin is the only pigment that exists in the eye; there is no pigment for hazel or green — or blue. Eyes only appear to be these colors because of the way light strikes the layers of the iris and reflects back toward the viewer.

3. You can’t predict if a child will have blue eyes
At one time, it was believed that eye color, blue eyes included, was a simple genetic trait. Common knowledge said that you could predict a child’s eye color if you knew the color of their parents’ eyes, and possibly the color of their grandparents’ eyes.
Or so we thought.
Geneticists now know that as many as 16 different genes influence eye color to some degree — far from the one or two genes that were once believed to determine iris hue.
In addition to genetics, the anatomic structure of the iris can also affect eye color to some degree.
In other words, it’s impossible to know for sure if your children will have blue eyes — or any other color. Both parents may have icy blue eyes, but that’s no guarantee their child’s eyes will even be blue at all.

4. Blue eyes at birth doesn’t mean blue eyes for life
Human eyes don’t have their full amount of melanin pigment at birth. This is why many babies are born with blue eyes, only to have their eye color change as their irises develop more melanin throughout early childhood.
So don’t be concerned if your child begins to lose their baby-blue eye color. It’s completely normal to see blue become brown, hazel, or even green as they get a little older.
This color transition can take anywhere from a few months to three years to run its course.

5. Blue eyes come with a few risks
Melanin in the iris appears to help protect the back of the eye (retina) from damage caused by the UV radiation and high-energy visible blue light that comes from the sun and some artificial sources.
Because blue eyes contain less melanin than most other eye colors, they may be more at risk of certain damage.

Research has shown that lighter iris colors are associated with:
• A higher risk of ocular uveal melanoma (a type of eye cancer)
• A lower risk of developing cataracts
• No difference in the risk of developing age-related macular degeneration

Since many people with blue eye color are more sensitive to light and may have a higher risk of retinal damage from UV rays, eye doctors often recommend that people with blue eyes be a little more cautious about their exposure to sunlight.

Eye damage from UV and blue light appears to be related to your lifetime exposure to these rays, so wearing sunglasses that block 100% UV (and most blue light) should start during childhood, when possible.

Photochromic lenses are another way to protect blue eyes from UV radiation. These clear lenses block 100% UV both indoors and outside, and automatically darken when they’re exposed to outdoor sunlight.

https://www.skincanceroption.com/5-things-you-might-not-know-about-blue-eyes-but-should/
Horizon Medical Services

5 Things You Might Not Know About Blue Eyes But Should Beautiful Blue Eyes Be Very Careful and Protective of Your Eyes Because You are at Greater Risk of Eye and Skin Cancer

While damage from the sun is a major culprit behind skin cancer, there are other causes as well that go beyond sun damage.

The experts at Horizon Medical Services, South Florida’s premiere mobile skin cancer treatment option, compiled a list of other risks for skin cancer. They range from genetics to medications you may take.

According to the American Society of Clinical Oncology (ASCO) your risk of skin cancer may increase under the following conditions:

A Weak Immune System: Those with weakened or suppressed immune systems from organ transplants or conditions like HIV or leukemia are at higher risk of developing skin cancer.
That’s especially true of squamous cell carcinoma.

Fair Skin: Those with a fair complexion with blond or red hair and blue eyes as well as those with freckles need to be extra vigilant when it comes to skin cancer.

Race and Ethnicity: Individuals with white skin are more likely to develop Merkel cell carcinoma, which is a rare form of skin cancer.

Gender: An increased number of older white males and younger white females are developing skin cancer.

Age: Basal cell skin cancer, the most common form, and squamous cell cancers are more common among those over 50. ASCO reports that melanoma is one of the most common cancers among young adults, especially women.

In 2020, about 2,400 cases of melanoma were estimated to be diagnosed in people aged 15 to 29.

Inherited Syndromes: Rare genetic conditions may increase your risk of developing basal cell carcinoma.

One condition is called nevoid basal cell carcinoma syndrome or Gorlin syndrome.

Having multiple basal cell skin cancers and jaw cysts are the most common symptoms of the condition. Ninety percent of those with the syndrome have both of these.

Conditions like albinism and xeroderma pigmentosum (XP) increase a patient’s risk of squamous cell cancers. Those with XP have extreme sun sensitivity, which is why they’re at a high risk of skin cancer and other medical problems.

According to Stanford Healthcare melanoma can also be hereditary. Those with what’s called the familial atypical mole-melanoma syndrome (FAM-M syndrome) may be more susceptible to melanoma, the deadliest form of skin cancer.

And according to the Skin Cancer Foundation, 10 percent of those diagnosed with melanoma have a family member who has also had melanoma.

Human papillomavirus (HPV): The HPV virus can be a risk factor for squamous cell carcinoma, particularly in a person whose immune system is suppressed.

Merkel Cell Polyomavirus or MCV: Studies show there is a link between the virus and Merkel cell carcinoma. In fact, MCV is present in about 80% of Merkel skin cancers.

Indoor Tanning: Much like sun exposure, indoor tanning can increase your odds of developing skin cancer.

Medications: Those taking immunosuppressive medications are also at an increased risk. The same can be true when taking steroids or other medications that make the skin more susceptible to sunburns.

Skin Cancer and Genetics
If you know your risk factors, especially genetic ones, you can better protect yourself.

More importantly you can be proactive when it comes to regular skin cancer checks. And while having a dermatologist perform a check in person is best, there are things you can do at home.

Skin Cancer Self-Checks
Perform regular skin checks of your whole body in front of a mirror.
Look at your arms, your hands, nails, between your fingers, and your underarms.
Examine your feet, toes, and your nails.
Check your neck and your back.
Also check your unmentionables for any concerning spots.
Have a partner or someone you trust look at your scalp and your back.
If you see something, go to the doctor right away.

Skin Cancer Treatment Miami
Skin cancer is treatable. The earlier it’s caught the better. The experts at Horizon Medical Services can help if you are diagnosed with skin cancer.

Horizon uses high-dose radiation (HDR) to treat skin cancers – including basal cell, squamous cell, and some melanomas. HDR is effective and spares healthy tissue surrounding the cancer site. There is also no, to little downtime, if any and patients avoid the risks of surgery.

The best part Horizon patients never have to go to a doctor’s office for treatment.

Horizon has vehicles specially equipped with the latest radiation technology, which travel to patients in Miami-Dade, Monroe, Broward, and Palm Beach Counties. Patients are treated inside the vans under the supervision of an oncology team and other skin cancer experts.

Most patients need 14 treatments with HDR, and most often there’s no scarring, which can be left by surgery.

To learn more about our mobile radiation therapy services for skin cancer treatment, call us at (954) 730-2333
Horizon Medical Services


https://www.skincanceroption.com/skin-cancer-and-genetics-causes-other-than-sun-exposure/

Skin Cancer and Genetics: Causes Other Than Sun Exposure | HMS We all want to know how Skin Cancer and Genetics are related. The short answer is, yes, they can be. Read more now!

Like many of us Ross grew up spending a lot of time outdoors. All day, every day he played under the Florida sun. Having light skin, hair and eyes he’s a prime candidate for skin cancer, so when he got older, it came as no surprise to him when he was diagnosed with skin cancer.

What did surprise him was discovering there is a medical service that comes to his home to treat skin cancer.

Horizon Medical Services provides skin cancer treatment inside their mobile medical vans right outside your home.

The oncology team uses radiation therapy to treat and cure skin cancer instead of surgery.

It is a painless procedure that leaves no scars unlike Mohs Surgery to cut out cancer.

Ross had Mohs surgery to remove skin cancer and says it was a very painful, a difficult experience and it took a long time for the incisions to heal, and was very time consuming.

With radiation therapy, which kills the cancer cells, there is no downtime.
The only side effect may be like a bit of a sunburn.

Horizon is the only mobile skin cancer treatment service nationwide and worldwide.

We treat patients from the Florida Keys to the West Palm Beach counties, and everywhere in-between.

You simply stay inside your home and we alert you when we’re about to arrive.

Then you step inside the medical van, get treated by our team of radiation oncologists, radiation therapists and physicists.

The whole process most often takes about half an hour, to an hour, depending on your needs, and afterwards you go back inside your home and go about your day.

There is no need to drive to a doctors office, medical or cancer center for treatment and wait to get treated and being exposed to who knows what.

This is a great service, not only for patients but for family members who would otherwise have to drive their elderly parents, or friends to get treated, because they don’t or can’t drive anymore.

We go to patients homes, condos, apartments, adult living centers, nursing homes, wherever our services are needed we come to you.

Yes it’s true our doctors make house calls.
If you are interested in our services call us at 954-730-2333
Horizon Medical Services

https://youtu.be/C78JBAGOlhM

Horizon Patient Testimonial Radiation vs Mohs Like many of us Ross grew up spending a lot of time outdoors. All day, every day he played under the Florida sun.Having light skin, hair and eyes he’s a prim...

Compared with the general public, veterans had a nearly 18% higher risk for being initially diagnosed with stage 3 melanoma, a recent study found.

U.S. veterans are at higher risk for melanoma, the deadliest form of skin cancer, than most Americans, and new research finds they are also more likely to have advanced-stage disease when it's detected.

At the time of diagnosis, "we found veterans with melanoma were more likely to present with 'regional' or 'distant' disease," explained study author Dr. Rebecca Hartman, an associate chief of dermatology with the VA Boston Healthcare System.
"Primary care providers and dermatologists who care for veterans, as well as veterans themselves, should be aware of the elevated advanced melanoma risk in this population," Hartman added.

Hartman encouraged physicians to screen veterans as high-risk patients and for veterans to use sunscreen whenever possible. Also, quickly seek medical advice if and when lesions pop up, she said.
Regional disease, also known as stage 3 melanoma, is when tumor cells have spread from the original site of skin cancer to nearby lymph nodes, lymph vessels and/or other skin sites.

More advanced stage 4 ("distant") melanoma is when cancer has spread from the original problem site into the bloodstream, taking hold in relatively distant areas such as the lungs, liver or brain.

Veterans were also found to have relatively worse prospects for surviving their moderate- to advanced-stage illness, added Hartman, though she noted that survival odds have improved in recent years.

More advanced stage 4 ("distant") melanoma is when cancer has spread from the original problem site into the bloodstream, taking hold in relatively distant areas such as the lungs, liver or brain.

Veterans were also found to have relatively worse prospects for surviving their moderate- to advanced-stage illness, added Hartman, though she noted that survival odds have improved in recent years.

According to the American Cancer Society, skin cancer is the most common form of cancer. Although melanoma accounts for just 1% of those cancers, it's the biggest skin cancer killer by far.
Among veterans, melanoma is the fourth-most common form of cancer, and this group is particularly vulnerable for several reasons, the study team noted.

One is that being older, white and male are all high-risk factors. The cancer society pointed out that melanoma risk is about 20 times higher among white people compared with Black people; and the study team said 80% of U.S. veterans are white. More than nine in 10 veterans are also men, and just over half are older than 65.

Lifestyle also plays a role, with veterans less likely to use sunscreen, but more likely to be exposed to cancerous UV sunlight. That, said Hartman, is due to "their service experiences, which often take place outdoors and in high UV environments," with additional radiation exposure risk seen among Air Force veterans.

For the study, the investigators analyzed information gathered between 2009 and 2017 by the SEER (Surveillance, Epidemiology and End Results) program. SEER looks at cancer risk in one-third of the general U.S. population, among whom 166,000 non-vet melanoma patients were identified.

That data was then stacked up against information collected by the Veterans Affairs Central Cancer Registry over the same time frame. During that period, more than 15,000 vets were diagnosed with melanoma.

The result: By nearly all measures, veterans faced worse melanoma prospects.
Compared with the general public, veterans had a nearly 18% higher risk for being initially diagnosed with stage 3 melanoma. Veterans also faced a 13% higher risk for getting an initial diagnosis of stage 4 melanoma.

And the chance that a veteran would not die from their cancer within five years after their diagnosis was consistently worse across all stages and ages, except for those diagnosed at age 80 year or older, the findings showed.

There were some bright spots, however. For example, among all patients with stage 4 illness, two-year survival odds improved both among the general public and among veterans, suggesting that new melanoma treatments are reaping rewards.

Specifically, two-year survival odds among stage 4 veterans rose from less than 38% between 2011 and 2014 to nearly 52% by 2015 to 2017. The jump among veterans exceeded the improvement seen among the general public.

Kim Miller is a cancer society scientist in surveillance research. She said she was "not altogether surprised by the findings," given that the vast majority (97%) of patients in the veteran analysis were men, while men accounted for only 57% in the general public pool of melanoma patients.
However, she pointed to one point of good news: "that veterans and the general population have both benefited from advances in immunotherapy and targeted drugs for stage 4 melanoma."

Also, the slightly better survival improvement seen among veterans, she said, might reflect the fact that those in the military actually have "better access to systemic treatments" compared with the general public.

Miller said it's important to know that "melanoma is highly preventable through the use of a broad-spectrum sunscreen (30 SPF or higher) and other behaviors, such as using protective clothing." And when melanoma does occur, catching it early is "critical," she said, when survival odds are far better.

Horizon Medical Services
https://www.skincanceroption.com/u-s-veterans-at-higher-risk-for-deadly-skin-cancer-melanoma/

U.S. Veterans at Higher Risk for Deadly Skin Cancer Melanoma U.S. Veterans need to make sure they get annual skin checks because they are at higher risk of skin cancer

In my last 13 years of immersion in dermatology, I have often asked this simple yet elusive question of my superiors, my colleagues, and myself: Which patients need skin checks? As I peruse my clinical schedule, in which the majority of patients receive total-body skin examinations (TBSE), there lies a persistent impediment — there are patients who want to be seen “too often,” some whom are seen “too little,” and others who seem “just right.” Akin to the fairy tale by Katharine Pyle, Goldilocks and the Three Bears(1918), the age-old dilemma of balance, namely that of time, risk-based resource management, and patient preference, shapes each clinical day. How do we curate a clinical schedule that targets patients who need our prevention and care the most? Article By: Dr. Lorraine L. Rosamilia

If we deconstruct the sentence in question, its simplicity turns to confusion:

DO (Yes or no?)

I (Me? My family?)

NEED (Require or prefer? How often?)

A SKIN CHECK (Full body? Partial? By the dermatologist or primary care physician?)

Hence, I scrutinized the recent literature for guidance. Firstly, the TBSE is safe and well-received by patients, with negligible morbidity. In 2016, the United States Preventative Services Task Force (USPSTF) reported that there is insufficient evidence to broadly recommend TBSEs. However, the amassed USPSTF data were derived from all skin screenings, including those by non-dermatologists, and did not specify specialty-specific benefits or morbidity/mortality for high risk groups. USPSTF guidelines only target primary care trends, therefore, specialty societies such as our American Academy of Dermatology (AAD) issued subsequent statements outlining salient clarifications, namely that TBSE detects melanoma and keratinocyte carcinomas earlier than in patients who are not screened. Unfortunately, randomized controlled trials to validate these observations are sparse, particularly due to the ethics of withholding screening from a prospective study group. To make sense of this dilemma, Johnson et al in 2017 outlined the best available survival data in concert with the USPSTF statement to arrive at judicious dermatology-specific skin cancer screening recommendations. They concluded that high risk patients, namely those with history of skin cancer, immunosuppression, indoor tanning, and/or many blistering sunburns, as well as several other genetic parameters, would benefit most from at least yearly TBSE.

Regrettably, the techniques and reproducibility of TBSEs are also not standardized, though TBSE methods seem to have been endearingly apprenticed behind closed doors to generations of dermatology trainees, without much in the way of practical teaching modules, examination logs, or live board certification proficiency.

Earlier this year, Helm et al proposed standardizing the TBSE sequence to minimize omitted areas of the body, which may become an imperative tool for streamlined resident teaching and optimal screening encounters.

Depending on patient body surface area, mobility, willingness to disrobe, and adornments, multiple factors may restrict full view of a patient’s skin, however.

For instance, some patients refuse a gown or removal of certain clothing items (e.g., undergarments, socks, wigs), and based on a recent cross-sectional study by McClatchey et al, if the patient has never had a TBSE, they are less willing to have sensitive areas of the body examined by a provider of the opposite gender.

They also, nonetheless, reported that 84% of patients expected ge***al and breast examination during TBSE but most did not feel as though they required a chaperone in the room.

Taking this tug-of-war into account to arrive at the most thorough TBSE, perhaps TBSE expectations should be explored at the outset, such as pre-visit literature and staff explanation of TBSE logistics.

Wholly, we should not shame, coerce, or assume patient compliance with ‘total’ examination but instead view as much as patients are able and comfortable to show us, welcoming that we have the opportunity to take care of them and screen for cancer in any capacity. In underserved or limited-budget practice regions, lesion-directed versus TBSE may be the only possible screening method and may even attract more patients to a screening facility.

Frequency of TBSE also remains under debate. In the U.S., dermatologist density is 3.4 per 100,000 people, a ratio that cannot undertake mass screening of all Americans in a particular age range like mammography and dental screenings do. In an ideal universe, the aforementioned high-risk groups would receive expedited screening, but the Goldilocks scenario applies; no one eats the porridge at the perfect temperature all the time. No practice or patient population is comparable with respect to its risk factors, geography, medical care access, education, or expectations.

Managing this balance includes many tactics and schedule permutations specific to each dermatologist’s milieu. Most practices give patients with a history of melanoma priority status so that any visit cancellations or delays are rescheduled preferentially. However, some of these at-risk patients defer yearly TBSE upon checkout and schedule an appointment only when a lesion of concern arises.

In the opposite corner are those patients who deem the recommended TBSE interval as too infrequent, which poses a delicate dilemma and another cohort of risks, namely that the patient may become (or continue to be) overly fixated on the small details of every skin lesion, and develop the habit of expecting frequent and self-directed biopsies.

This may lead to a difficult discussion about oversampling lesions and the potential for many scars, copious re-excisions for ambiguous lesional pathology, and a trend away from prudent clinical care. In addition, multiple visits incur more patient co-pays and absence from school, work, or home.

Most dermatologists therefore advise all patients to call for a more acute visit if there is a lesion of concern and also recommend taking home photographs.

Further, self- or partner-examination between visits is an intuitively valuable screening adjunct.

In 2018, the USPSTF recommended behavioral skin cancer prevention counseling and self-examination only for younger-age cohorts with fair skin (6 months to 24 years), but again its utility in specialty practice was not qualified.

This amassed more confusion, so the AAD Association subsequently issued a statement to support safe sun-protective practices and diligent self-screening for changing lesions for all patients, as earlier detection and management of skin cancer can lead to decreased morbidity and mortality from these neoplasms.

My expedition into the literature was a quandary. We are considered to be part of a patient’s cancer surveillance team, but no single body can decide whom should be screened, how often, and if it matters for survival.

Moreover, throwing a wider net for screening leaves no availability for dermatologists to care for other skin conditions or allow acute visit slots for worrisome evolving lesions. What do we do? Despite being a small specialty, we have a large duty in this cancer arena, because the incidence of melanoma in 2018 was almost 100,000 cases (American Cancer Society); our training is strong, our community mindedness is large, and our organizing bodies promote stewardship of resources and expertise to patients most in need. Leaning on the consensus statements by the AAD and AADA above, you can shape your community’s approach to its skin cancer risk factors and screening practices and save lives, and the data will follow.

Conclusion: Perform TBSEs in a consistent manner with a consistent message, while attempting to dictate the number of appointment slots and preferences allotted for high risk patients. Stay tuned. As of September 2019, the ABD says there are just under 15,000 board-certified dermatologists in the U.S.; our brain trust and resolve will help us define optimal skin cancer screening practices. We need to be “loud voices” in the governing bodies that shape guidelines that are “just right.”

Point to remember: TBSE is the bedrock of dermatologic cancer screening, but its methods and frequency are yet to be standardized into agreed-upon guidelines. Amassed data from the USPSTF, AAD, and well-respected academic centers are attempting to determine which high-risk groups should be preferentially screened, namely those with history of skin cancer, immunosuppression, indoor tanning and/or many blistering sunburns, and several other genetic parameters.

Our Expert’s Viewpoint
Jeffrey J. Miller, MD
Professor and Chair of Dermatology
PennState Health and College of Medicine

Dr. Rosamilia thoroughly reveals the Naked Truth About Total Skin Examination, the dermatologist’s most important physical exam tool. Expanding on her Goldilocks metaphor, we, as a highly specialized group, have a challenge and an opportunity to get the TBSE “just right.” The challenge is to develop and validate a standardized process to perform the TBSE. The opportunity is to introduce the TBSE into medical school curricula and residency program training. To date, our dermatology specialization, which has enabled each of us to develop our own efficient and effective TBSE, creates a coordination problem in that we do not have a common language or procedure for the TBSE that could lead to integration of the TBSE into medical school curriculum focused on the physical exam skills. The other opportunity is to provide the evidence on the value of the TBSE that would then lead to more widespread incorporation of TBSEs into routine physical exams by primary care clinicians and to endorsement by the United States Preventative Services Task Force (USPSTF). I agree with Dr. Rosamilia that we would need to define the population who will benefit from the TBSE, especially given the mismatch between our current workforce and patient demand. I believe that machine-based learning, artificial intelligence, and automated total body skin scanning will augment our ability to access more patients in the future but will never replace the TBSE by an experienced, compassionate dermatologist. I vividly remember the time I had to tell my patient that I missed his biopsy-proven melanoma on his left flank at his 12-month follow up visit. I was humbled by my own limitations and used this failure as an opportunity to rededicate myself to the TBSE. Having a standardized process to perform my TBSE helps me create a mental checklist to examine all body parts.

I believe that we must continue to advance the TBSE as a physician exam skill that is “just right” through further investigation, including studies which examine the patient’s perspective of the TBSE.

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https://www.skincanceroption.com/the-naked-truth-about-total-body-skin-examination-a-lesson-from-goldilocks-and-the-three-bears/

THE NAKED TRUTH ABOUT TOTAL BODY SKIN EXAMINATION: A LESSON FROM GOLDILOCKS AND THE THREE BEARS When should you get a skin cancer check? The American Academy of Dermatology breaks it down for you depending on your family history