Jan. 28, 2021 -- Mary Bashir, a 48-year-old Boston-area high school teacher, is no stranger to skin cancer screenings. The beauty marks dotting her skin have always made her hyper-vigilant about check-ups.
But when she noticed a red dot on her nose -- about the size of a Sharpie tip -- she had a difficult decision to make. It was the beginning of the COVID-19 pandemic, and she wasn’t even going into grocery stores, let alone medical settings.
“The last place I wanted to go was a doctor’s office,” Bashir says. “I just had to consider the potential risks of letting something like that go.”
Her gut told her to go in sooner than later, and she listened. The dot turned out to be basal cell carcinoma, a common type of skin cancer that, if left untreated, can spread to nearby bone or tissue. On May 1, she had a procedure to remove it.
Dermatologists warn there are thousands of patients out there who, like Bashir, are hesitant to head into a clinical setting because of COVID concerns. But unlike Bashir, many patients opt to wait it out -- and the consequences, they say, may be deadly.
Though there is no data yet on how COVID-19 has affected skin cancer screenings, cancer screenings overall seen a significant dip. Findings released in May 2020 by the Epic Health Research Network show a drop between 86% and 94% in preventive cancer screenings nationwide, compared with equivalent weeks from 2017 to 2019.
“This is a situation that's a national crisis,” says Jukes Namm, MD, a surgical oncologist at Loma Linda University Health in California. “Our dermatology group’s numbers have gone down significantly. Patients are worried and afraid they'll get COVID, so they don’t come in.”
But he predicts the real consequences are yet to come. Those likely won’t be apparent until this summer, when people who have put off visits come in with more advanced skin cancers. And, he says, transmission usually happens in social gatherings, not at doctor’s offices.
Like many other types of doctor’s offices, dermatology offices have had a dramatic increase in virtual visits. But while video works well for mental health appointments and more general checkups, it isn’t the ideal method for skin screening, says Abigail Waldman, MD, an assistant professor of dermatology at Harvard Medical School and clinical director of Mohs surgery, a common skin cancer treatment, at Brigham and Women’s Hospital.
“Using FaceTime or Zoom, or having a good photo, can be good for a one-spot check to determine if the patient should come in,” Waldman says. “But there are limitations, and it can’t be used for regular screenings. It’s awkward to get naked in front of a camera.”
Skin cancer is the most common form of cancer in the United States -- it is estimated that 1 in 5 Americans will develop it at some point in their lives. About 9,500 people in the U.S. are diagnosed with skin cancer every day.
And, Waldman says, waiting can be a death sentence in some cases.
“For every benign lesion I see, we have just as many stories of aggressive skin cancers that are time-sensitive in terms of treating,” she says.
Though dermatology appointments should not be skipped or put off, people can perform at-home screenings and pay close attention to spots on their skin, Waldman says. This includes looking for new moles, pimples that have been around for 6-8 weeks, or moles that were once round and are now oddly shaped. Changes in color can also be a bad sign.
After her own scare, Bashir is encouraging others to get examined regularly, despite the ongoing fear of contracting COVID-19.
“I would invite people to consider what the consequences might be of putting this off,” she says. “Health concerns left untreated tend to get worse, not better.”