Overall I would say I had a great experience in pharmacy school at UNC-Chapel Hill and felt well-prepared to enter practice after graduation. Unfortunately, though, there is one big exception to that: dermatology.
From what I understand, this is most people's experience in pharmacy school; that's unfortunate, because it's a common reason people come to the pharmacy.
When I worked for Safeway in Kihei, Hawaii, the store almost always died down after about 7:30PM or 8PM. We ran a tight ship there, so most of the time outdates were already done, prescriptions were filed, and shelves were dusted. In other words, even when I looked for something to do, there wasn't much pharmacy-related work to be had.
I decided, especially after having tourists every week showing me their "heat rash" they had for four days, learning more about dermatology might be a good use of my last hour or so. Obviously I'm not a doctor, but some familiarity is good. After all, to some extent we have to triage it - can it wait for a few days until they get home from vacation? Should they see a doctor first thing in the morning? Do they need to go the ER? We all know at some point the pharmacist has to make these calls about the patient's "heat rash."
I stumbled upon the AAD Basic Course, which I highly recommend (it's free by the way). They basically created an entire medical student and/or resident dermatology curriculum that can be sorted by topic. I worked my way through the big ones (every pharmacist should go through their module on drug reactions), including melanoma, browsing the slides as I was able to at the end of the day.
Later on, I was giving a vaccine and the lady pulled her arm sleeve up and there was a very suspicious mole on her upper arm. She didn't seem too concerned, but I spent by far more time trying to convince her to see her dermatologist than I did giving the vaccine. If I remember correctly I even called her dermatology office to see if they would call her. I didn't ever see her in the pharmacy again (she wasn't a regular), but I hope she got it looked at.
After this experience I understood the payoff of focusing on this topic, and today I want to share some basic melanoma information with you. Anyone can learn these basics, and from a public health perspective I wish it could be incorporated into the curriculum of many professions, even cosmetologists and massage therapists, so that we could collectively save lives. If you think this is crazy, look at this study where barbers screened patients for hypertension and got them in the doctor's office.
To clear up one myth, melanoma can and does occur in dark-skinned individuals as well. Bob Marley, for example, passed from melanoma at age 36.
SPOTTING A POSSIBLE MELANOMA
The acronym ABCDE is most commonly used to remember melanoma warnings signs:
A - Asymmetrical
If you drew a line through the middle of it, would both sides match? Benign lesions are more often symmetrical.
B - Border
An uneven border (i.e. jagged edges), as
this picture shows.
C - Color
Again, as this picture shows, some parts of the lesion are darker in color while others are lighter. Benign lesions are more often even in color.
D - Diameter
While a lesion of any size can be concerning, those larger than a pencil eraser especially warrant further attention.
E - Evolving
Moles that change over time are a warning sign of melanoma.
Another tool providers use, especially for those patients who have a lot of moles (like on their back), is the "ugly duckling" approach: look for moles that stand out from the rest on the body. Benign moles often look more like each other than cancerous moles on the same individual.
Melanomas also often itch or bleed, but certainly don't have to.
Keep in mind, these are general rules and a melanoma can appear in unusual ways, such as an "amelanotic melanoma" that actually doesn't have any pigment. The only way to know for sure is to go to the dermatologist. They can further examine and determine if it should be biopsied. As pharmacists, our biggest role we can play in this area (and actually in many ways) is urging patients to see their provider and get the care they need.
I'll never know as much about the subject as someone who spent 5 years in a dermatology residency and does it day in and day out, but I can learn enough be an extra set of eyes on their patients in between office visits, especially while giving vaccines.
I'm not asking pharmacists to perform skin exams on patients (clearly outside of our scope of practice), but I am asking pharmacists to keep an eye out as patients come to you, even for unrelated things, or call that suspicious mole a heat rash and ask you if they can put hydrocortisone cream on it.
We can also play a big role in preventing skin cancer by educating and pushing for sun safety as well as encouraging them to perform regular skin exams.
The Bottom Line
We often say that as pharmacists we are the 'most accessible healthcare provider,' and with that we have a responsibility in promoting the public health. 20 Americans die every day from melanoma, and by learning to spot the warning signs we might save our patients', or family members', or our own lives.
Keywords: melanoma, skin cancer, skin exam, pharmacy service, sun safety
