Screening and Intervention for Skin Cancer in the Galapagos. (July 2020)

• Record Type: Journal Article
• Authors: Ayasse, Marissa T.; Marquez, Jocellie E.; Lozeau, Daniel F.; Slutsky, Jordan B.; Kaufmann, Tara L.; Lee, Yoojin; Scriven, Richard J.; Dagum, Alexander B.
• Is Part Of: Annals of plastic surgery. Volume 85(2020)Supplement 1 1S
• Publication Date: 2020-07
• Subjects: skin cancer -- screening -- Galapagos -- access to care -- melanoma -- basal cell carcinoma -- squamous cell carcinoma -- global health; Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/SAP.0000000000002345
• Languages: English
• ISSNs: 0148-7043

Abstract

Abstract : Objective: This study aimed to assess the general dermatological needs and correlation of tentative skin cancer screening diagnoses with histopathological confirmation in the highly sun-exposed locals of the Galapagos Islands. Methods: An institutional review board–approved prospective study was performed at Blanca's House, a nonprofit surgical volunteer organization, free clinics in the Galapagos. After consent, a 40-item modified SPOTme-inspired questionnaire was completed. Partial or total body skin examinations were conducted by board-certified dermatologists. Board-certified plastic and general surgeons performed excisional biopsies on suspicious lesions. Individuals younger than 18 years, and non-Spanish or non-English speakers were excluded. Results: A total of 273 patients were included in the study, of which 202 reported skin concerns. Benign nevi (n = 76), seborrheic keratosis (n = 42), melasma (n = 19), actinic keratosis (n = 16), acne (n = 15), eczema (n = 13), fungal infections (n = 12), seborrheic dermatitis (n = 5), and psoriasis (n = 5) were most commonly identified. Twelve patients (4.4%) had presumptive skin cancer after screening. Six of 8 biopsies confirmed cancer (group 1), 2 declined a biopsy and 2 were unresectable. Seven basal cell carcinomas and one squamous cell carcinoma were excised with clear margins. A right lower eyelid melanoma was diagnosed and subsequently treated in the United States where invasive melanoma with a Breslow thickness of 0.3 mm was found. Compared with the noncancer group (group 2: n = 265), group 1 had significantly higher likelihood of reporting having seen a dermatologist ( P = 0.02), taking any medications ( P = 0.0001), having blonde or red hair ( P = 0.01), having blue or green eyes ( P < 0.0001), and having used indoor tanning equipment ( P < 0.0001). Group 1 was also more likely to report 4 or more blistering sunburns ( P = 0.08), which approached significance. When evaluated by a dermatologist, group 1 was significantly more likely to be classified as "high risk" for developing cancerous lesions ( P < 0.0001) compared with group 2. Conclusions: Skin concerns in the Galapagos included benign and malignant conditions. There is a need for dermatological care in this medically underserved population. This modified SPOTme-inspired skin cancer questionnaire, confirmed by histology, is a useful tool in identifying high-risk patients and detecting skin cancer in international communities that would have otherwise experienced delays in diagnosis or treatment. Abstract : Supplemental digital content is available in the text.