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Keywords

Clinical Practice in Athletic Training

Abstract

Background: Skin cancer is the most common type of cancer in the United States. One in five Americans will be diagnosed with skin cancer in their lifetime, or about 9500/day. Research indicates that nonmelanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), affects more than 3 million Americans a year. More than 1 million Americans are living with Melanoma, nearly 200,000 cases of melanoma were diagnosed in 2022 with about 98,000 being invasive and 100,000 being non-invasive (in situ). The average age of diagnosis is 65. Melanoma rates in the US have been rising rapidly over the past 30 years, doubling between 1982 and 2011, but trends vary by age. In 2018, the Centers for Disease Control (CDC) reported 8,199 people died from melanoma. By making sun safety a habit, people can avoid sunburns and reduce the risk of melanoma. Patient: 47-year-old, Caucasian male with red hair, who spends a significant amount of time outside working as an athletic trainer. He had a history of blistering sunburns as a child, mostly on shoulders, nose and ears. He previously has had 4 suspicious lesions removed on head and back. The patient has bi-annual skin checks performed at a dermatologist’s office. During his 8/1/2023 skin check, a small suspicious lesion was noted on his left jaw line, just inferior to his ear and posterior to the angle of the mandible. Patient was not aware of the lesion. The lesion was excised and sent for testing (see images below). Differential Diagnosis: Squamous Cell Carcinoma, Basal Cell Carcinoma, Invasive Melanoma, Non-Invasive Melanoma. Treatment: On August 6, 2023 results showed melanoma in situ (non-invasive). The dermatologist referred patient to a second dermatology procedure, a Slow Mohs procedure, which was scheduled for September 18, 2023. Results the next day showed melanoma in situ at site 1 (located posterior to Left ear lobe). A second Slow Mohs procedure was performed the following day (9/20/2023) with results on 9/21/2023 showing no additional melanoma present. Outcome/Comparison: A Slow Mohs procedure is a staged surgical excision used to precisely remove skin cancer while trying to save as much normal healthy skin around it. The tissue is processed in the Mohs method to allow a pathologist to examine 100% of the margins and allow the surgeon to “trace” the roots. The procedure went as expected and the outcome was considered very good, with continued follow ups every 4 months for the first year, then back to 6 months thereafter. Conclusion: This case illustrates the need for regular skin checks and appropriate skin care for all people who spend a significant time in the sun. Learning what to look for as an individual can help to identify an irregular mole and know when a referral to a dermatologist is required. Suspicious changes to pigmented areas should be monitored and evaluated using the mnemonic ABCDE: A – Asymmetry - What is the shape? B – Border - What do the contours look like? C – Color - How many colors? D – Dimension - What size? E – Evolution - Have you noticed a recent change in one of the above? Clinical Bottom Line: Athletic Trainers, like any outdoor athlete, have the potential for significant UV exposure. Sun protection should include sunscreen, protective clothing and behavioral changes, including regular skin checks. Outdoor winter sports are just as susceptible to UV exposure as outdoor summer sports

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