An educational intervention study evaluating a pharmacist-directed skin screening program
Purpose: Skin cancer is the most prevalent form of cancer in the United States and the incidence continues to increase. Actinic keratosis is the most common precancerous condition with over one-half of the adult population reporting having a sunburn in the last 12 months. Over 90% of nonmelanoma skin cancers are caused by UV exposure. Prevention and education are key factors in modifying this risk. The purpose was to have pharmacy screen patients to educate them on their specific risks of sun damage, as well as proper prevention strategies to limit damage, and in turn, decrease the incidence of skin cancer.
Methods: The Institutional Review Board approved this screening and educational intervention study as part of an employer-based wellness program. An announcement went to all employees asking for participation in the study. Eighty patients volunteered and were screened by pharmacists and student pharmacists with the Skin Scope FS 112-P (Ikonna). The skin scope machine uses a black light to show dry skin, dead skin, oily skin, thin skin, and hyperpigmented of the skin on the face. Student pharmacists performed the skin scope and charted any abnormalities on a blank face form designed by the team. Each patient’s results were discussed with them and education was provided. All patients were counseled on skin protection, however, based on the severity of their sun damage, some patients were referred to a dermatologist. Educational materials (available on the employer website) were designed by the pharmacy and were provided for patients to take home. The results of the screening were placed in a confidential database and analyzed using descriptive statistics. The primary outcome variables were the number of referrals and severity of damage. Additional variables included age, gender, sun-sensitizing medication, and number of hours in the sun per week in summer and winter.
Results: Eighty patients signed the informed consent and fully participated in the study. The skin scope screening took an average of 3 minutes to perform with an average time to counsel a patient of 3 to 5 minutes. Females represented 82.5% of the study with the average age being 44.7 years. Ten percent reported being on a sun-sensitizing medication. Of the patients examined, 43.75% were referred to a dermatologist based on severity of damage noted on the skin scope results and/or a strong family history of skin cancer. The severity index was based on a 5-point scale with 1 representing mild damage, 3 representing moderate damage and 5 representing severe damage. The average severity score of those patients referred to a dermatologist was 1.8 representing mild to moderate severity. Eight patients (10%) scored moderate to severe damage. The average number of hours in the sun during the summer was 16.3 hours per week while the average for the winter was 5.6 hours.
Conclusion: Pharmacists and student pharmacists can play a critical role in educating and screening patients for the most common type of cancer. The skin scope is useful in helping patients understand the consequences of sun exposure. This study demonstrated that a high percentage of patients would benefit from a referral to a dermatologist. Evidence suggests that early detection is a critical component in reducing the risk of advanced skin cancers. Pharmacists are in an ideal setting to counsel patients on proper skin care including prevention with sunscreen and sun-sensitizing medications. This program can easily be duplicated in any ambulatory pharmacy setting.
An educational intervention study evaluating a pharmacist-directed skin screening program.