Book Description

About 5 million cases of skin cancer will be diagnosed in the United States in 2015, making skin cancer the most common cancer diagnosis in the United States. About 13,000 Americans will die from skin cancer in 2015. Often skin cancers are diagnosed at later stages, are expensive to treat, and result in fatalities. For melanoma, responsible for 75% of skin cancer deaths, the overall 5-year survival rate is 98% for skin lesions detected in their early stages, and this survival rate drops to 16% after the disease has spread to other organs. If these fatal skin cancers were detected earlier they would cost less to treat and result in better patient outcomes. There is no single resource available that maps the full state of the skin cancer care delivery, and most current views are colored by a stakeholder's perspective. We connected with stakeholders at different levels of the skin cancer care delivery system to create an overall picture of the system's current state and to identify gaps in care. We interviewed 9 skin cancer patients, 8 primary care physicians, and 9 dermatologists. Through this research, we discovered that the structure of how skin cancer care is delivered promotes opportunities to miss skin cancers and includes many barriers between initial cancer suspicion and disease diagnosis. Frequently patients do not evaluate themselves for skin cancer, primary care physicians have low accuracy in identifying skin cancers, and dermatologists manage a very small portion of the population who develop skin cancers. At a higher level, feedback between patients and physicians is frequently lost in the system, physicians are not accountable for patient outcomes, and patient health is not supported by the system until the patient identifies a health issue and acts to remedy the issue. To close these system gaps, we identified technologies, including micro-biopsies and electrical impedance spectrometry, which could be used to improve rates of skin cancer identification and promote better patient health outcomes. Additionally, we recommend physicians find a way to collaborate on cases, identify their own weaknesses in assessment, and capture patient outcomes to relay incorrect assessments to other physicians to improve future patient care.