William Scherer, DPM, MS presented data at the Midwest Podiatry conference on 15,000 lower extremity malignancies. He notes that this information is as of yet unpublished and comes from a 10-year review of BakoDx pathology reports from about 7,000 podiatrists that diagnosed skin cancers.

“When the data was organized into the most common skin cancers, what I discovered was quite fascinating, as it clearly showed that malignancies in the lower extremity are represented in far different patterns as compared to skin cancer studies that encompass the entire body,” says Dr. Scherer.

The database review of the malignancies revealed that 56 percent of all skin cancers submitted to the lab in question were squamous cell carcinoma, in sharp contrast to studies that demonstrate this skin cancer is present in 18 percent of total body skin cancer.

Also, he relates that basal cell carcinoma comprised 21 percent of the malignancies in their review, yet it accounts for nearly four times that incidence in total body skin cancers. Lastly, malignant melanoma represented a much higher incidence in this lower extremity review than the known total body skin cancer incidence.

“Unfortunately, I don’t have an answer as to why the distribution percentages between total body and just lower extremity skin cancer differ so much,” he adds.

Dr. Scherer shares that he feels the simplest, and most basic thing podiatrists can do to improve their skin cancer diagnostic skills is to perform a total lower extremity skin evaluation on every patient that they encounter, no matter what their chief complaint is. This is important, he adds, as most skin cancers are non-painful and patients tend to not notice skin growths that do not cause them pain.

“I also think it is helpful to have skin cancer posters on the walls of every treatment room and even in the patient waiting area, as these visual reminders can promote conversations between the patient and podiatrist about possible skin cancer that may be overlooked,” he says.

He stresses that performing more punch biopsies on suspected lesions is another action point DPMs can take. Despite key opinion leaders also encouraging this practice, he says, he notes that data he has reviewed from Medicare shows that podiatrists do not perform as many biopsies as dermatologists, and some never perform them.

“In my opinion, there is no question, that if a podiatrist is seeing an average of 50 to 75 patients per week, then they statistically should be diagnosing skin cancer at least once every few months,” he shares. 

Dr. Scherer is a Diplomate of the American Board of Foot and Ankle Surgery and practices in South Florida. He discloses he is a Senior Podiatric Medical Advisor, Clinical Consultant and Speaker for Bako Diagnostics.