Dermatology: Practical and Conceptual Letter | Dermatol Pract Concept 2020;10(1):e2020014 1 Dermatology Practical & Conceptual Introduction Early diagnosis of skin cancer is associated with a reduction in morbidity/mortality and in treatment costs [1]. The benefits of screening programs (especially for melanoma), however, have not been conclusively demonstrated. Methods During this 6-month-long, observational study, data were prospectively collected in the dermatology department of a university hospital. Patients included in the study had a pathology-confirmed diagnosis of basal cell carcinoma, squamous cell carcinoma, melanoma, or keratoacanthoma. Those who suffered from cognitive decline or loss of sen- sory perception that impeded their noticing a skin tumor were excluded. The data collected included risk factors for skin cancer, personal and family background regarding skin tumors, sunburn events, phototype (I/II), multiple atypical nevi, whether the patient had undergone solid organ trans- plantation, and demographic data. Information was also collected on who first noticed the lesion: the patient, a family member or some other person, a dermatologist, or a doctor specializing in another field. Results The study population totaled 184 patients, 12 of whom had 2 skin malignancies. The most commonly detected was basal cell carcinoma (60.7%, 119 tumors), followed by melanoma (19.4%, 38), squamous cell carcinoma (17.4%, 34), and keratoacanthoma (2.5%, 5). Tumor duration had 2 main peaks, one at 6-12 months (25%) and one at more than 24 months (26%). Figure 1 shows the risk factors detected. The patient was the first to detect the lesion in 54.3% of cases (100/184 patients), someone in the patient’s environment was first in 15.2% of cases (28/184 patients), a dermatologist in 22.3% of cases (41/184 patients), and a doctor special- Who Detects Skin Cancer? Factors Associated With the Suspicion of Malignancy in Patients With Skin Tumors Alberto Conde-Taboada,1 Laura Croissier1, Elena González-Guerra1, Lucía Campos1, Beatriz Aranegui2, Eduardo López-Bran1 1 Dermatology Department, Hospital Clínico San Carlos, Madrid Spain 2 Dermatology Department, Hospital Infanta Cristina Parla, Madrid, Spain Key words: skin cancer, early detection, dermatology education, melanoma, basal cell carcinoma, squamous cell carcinoma Citation: Conde-Taboada A, Croissier L, González-Guerra E, Campos L, Aranegui B, López-Bran E. Who detects skin cancer? Factors associated with the suspicion of malignancy in patients with skin tumors. Dermatol Pract Concept. 2020;10(1):e2020014. DOI: https://doi. org/10.5826/dpc.1001a14 Accepted: August 28, 2019; Published: December 31, 2019 Copyright: ©2019 Conde-Taboada et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. Authorship: All authors have contributed significantly to this publication. Corresponding author: Alberto Conde-Taboada, MD, C/ Prof. Martín Lagos S/N, Madrid 28023, Spain. Email: condetaboada@aedv.es mailto:condetaboada@aedv.es 2 Letter | Dermatol Pract Concept 2020;10(1):e2020014 References 1. Aviles Izquierdo JA, Molina I, Rodriguez E, Marquez-Rodas I, Suarez-Fernandez R, Lazaro-Ochaita P. Who detects mela- noma? Impact of detection patterns on characteristics and prognosis of patients with melanoma. J Am Acad Dermatol. 2016;75(5):967-974. 2. Graells J, Ojeda RM. Ability of non-mel- anoma skin cancer patients to self detect second tumours. J Eur Acad Dermatol Venereol. 2009;23(2):180-181. established. Strategies are in place in Western countries for such follow-up by dermatologists. However, no pro- spective clinical trials have been per- formed to determine what the best fol- low-up strategy might be. Diagnosis was delayed more than 2 years in 26% of the present patients. This delay is associated with greater morbidity/mortality and higher treatment costs, justifying efforts to detect problems earlier. izing in another area in 8.2% of cases (15/184 patients). Patients who had had a previous skin tumor were more likely to be the first to have detected their present tumor. Having undergone solid organ transplantation was also significantly associated with the tumor being first detected by a dermatologist. No association was seen between who first identified the lesion and age, family background of skin cancer, sunburn events, the presence of multiple atypical nevi, phototype, or tumor duration. Discussion The present self-detection rate of this study is similar to those reported for melanoma in other publications [1]. Graells and Ojeda reported 42% of patients with a second basal cell or squamous cell carcinoma to be the first to detect it [2]. Our results confirm that the knowledge gained from previous episodes of skin cancer increases the likelihood of self-detection. On the other hand, patients who have under- gone solid organ transplantation are at greater risk of developing skin cancer; the present results show dermatologists are more likely to be the first to detect skin malignancies in such patients, likely as a result of the monitoring protocols Figure 1. Risk factors for development of skin cancer detected in the patients.