A lack of progress with secondary prevention, in terms of skin cancer screening and early detection, is a concern and a source of some disappointment among the dermatologist community.^1,2 Early detection and treatment of melanoma is critical to maximise survival.^3,4 Nevertheless, recently and for a second time the US Preventive Services Task Force (USPSTF) found insufficient evidence to recommend visual screening of adults for skin cancer following a systematic review.^1,5

Where does this leave us? It may feel like some kind of impasse, but it has been suggested that perhaps we simply need to shift our focus from secondary to primary prevention.¹

With exposure to ultraviolet (UV) radiation established as the leading cause of skin cancer and the only modifiable risk factor,^6,7 this provides a singular target for primary prevention efforts. However, reducing UV exposure requires changes in behaviour and habits, which are not easy to achieve.^3,8 Despite skin cancer prevention recommendations, best practices and evidence-based interventions to reduce UV exposure, the incidence of skin cancer continues to rise worldwide.⁹ In the susceptible populations of the US (whites), the UK, Sweden and Norway, melanoma rates have increased at more than 3% annually over the last three decades, although Australia and Israel have bucked the trend with melanoma incidence declining by 0.7% and 3% per year, respectively, in these countries since 2005/2006.^10,11

Right now, digital technology is opening up many opportunities, not least in healthcare. Social media and online search engines enable targeted communication of health messages at the most relevant time. Persistent messaging on the need for sun protection measures at appropriate times may be effectively delivered through these channels. Furthermore, the concerning continued widespread use of tanning beds (group 1 carcinogen) among young people may be tackled head-on with direct communication to those seeking a tanning salon, for example.^1,12 Effectiveness of the communication would need to be measured and maximised, and perhaps there could be a role for machine learning to help in this respect. Certainly, tech giants have already identified the secondary prevention of skin cancer as an exciting avenue for applying artificial intelligence (AI) in healthcare.^13,14 In fact, at least two smartphone Apps already exist to aid in the diagnosis of skin cancer ( DermaCompare http://www.dermacompare.com/ and SkinVision https://skinvision.com/ ) using ‘big data’ and machine learning to constantly improve detection performance.

Only in the future will we know what real benefits digital technology can bring to healthcare. Although healthcare professionals (and dermatologists specifically) will no doubt continue to play pivotal roles in the treatment and management of skin cancer, if the technology opens up previously untapped or unimagined possibilities, the true role of dermatologists and other healthcare professionals may yet need to be defined. However, technological advances in secondary prevention are progressing rapidly, and the hope is that is they can help to make a significant difference to primary prevention in the face of continued projected growth in skin cancer incidence in many countries.¹⁰

Dominique du Crest

Acknowledgement:

I would like to thank Dr Michelle Levy, Medical and Cosmetic Dermatologist, Toronto, Canada, for her valuable advice and input on medical/scientific aspects during the development of this editorial.

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