Asking patients if a suspicious skin lesion is painful or itchy may help doctors decide whether the spot is likely to be cancerous, according to a new study headed by Gil Yosipovitch, MD, Chairman of the Department of Dermatology at Temple University School of Medicine.
The study, published online by JAMA Dermatology on July 23, 2014, found that nearly 36. 9 percent of skin cancer lesions are accompanied by itching, while 28.2 percent involve pain. Non-melanoma skin cancers -- specifically, basal cell carcinoma and squamous cell carcinoma -- are more likely than melanoma to involve itch or pain, the study found.
"The study highlights the importance of a simple bedside evaluation for the presence and intensity of pain or itch as an easily implementable tool for clinicians in evaluating suspicious skin lesions," concluded the study.
Dr. Yosipovitch, Director of the Temple Itch Center, said the findings are important because skin cancer is the most common cancer in the United States. More than 3.5 million non-melanoma skin cancers are diagnosed in two million people annually in this country.
"Patients sometimes have multiple lesions that are suspicious looking, and those that are itchy or painful should raise high concerns for non-melanoma skin cancers," Dr. Yosipovitch said.
The study involved 268 patients who had 339 laboratory-confirmed skin cancer lesions at Wake Forest University Baptist Medical Center from July 2010 to March 2011.
After undergoing a skin biopsy, the patients were asked to complete a numerical ranking scale to quantify the intensity of itch and pain associated with their skin lesion. The scale, called a visual analog scale, or VAS, went from zero (no sensation) to 10 (the most intense sensation imaginable).
When the researchers compared the patients' responses to their biopsy results, they found that:
- The prevalence of itch was greatest in squamous cell carcinoma (46.6 percent), followed by basal cell carcinoma (31.9 percent) and melanoma (14.8 percent).
- Pain prevalence was greatest in squamous cell carcinoma (42.5 percent), followed by basal cell carcinoma (19.9 percent) and melanoma (3.7 percent).
- Pain and itch often went hand in hand: 45.6 percent of lesions associated with itch also had pain; and 60 percent of painful lesions also involved itch.
- The most painful lesions tended to be those with the greatest depth (except for melanoma lesions, which did not correlate with pain). Pain and itch was also associated with lesions that were larger in diameter. Cancers that were ulcerated (sores or open wounds) tended to be associated with pain but not with itch.
- Pain and/or itch were more likely to be present when the laboratory analysis of the skin lesion sample suggested a marked or moderate degree of inflammation as compared to mild or no inflammation.
Dr. Yosipovitch said he hopes the study findings will prompt dermatologists to incorporate the use of a ranking scale for pain and itch when evaluating patients with suspicious skin lesions. "This could increase the detection of skin lesions that are cancerous," he said.
- Gil Yosipovitch, Kyle C. Mills, Leigh A. Nattkemper, Ashley Feneran, Tey Hong Liang, Brett M. Lowenthal, Daniel J. Pearce, Phillip M. Williford, Omar P. Sangueza, Ralph B. D’Agostino. Association of Pain and Itch With Depth of Invasion and Inflammatory Cell Constitution in Skin Cancer. JAMA Dermatology, 2014; DOI: 10.1001/jamadermatol.2014.895
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