Posted August 14, 2014

Study shows that pain and itch may be signs of skin cancer

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Asking patients if a suspicious skin lesion is painful or itchy may help doctors decide whether the spot is likely to be cancerous, according to a new study headed by Gil Yosipovitch, chair of the Department of Dermatology and director of the Temple Itch Center at Temple University School of Medicine.

The study, published online by JAMA Dermatology, involved 268 patients who had 339 laboratory-confirmed skin cancer lesions and found that nearly 37 percent of skin cancer lesions are accompanied by itching, while 28 percent involve pain. Nonmelanoma skin cancers—specifically, basal cell carcinoma and squamous cell carcinoma—are more likely than melanoma to involve itch or pain.

“The study highlights the importance of a simple bedside evaluation for the presence and intensity of pain or itch as an easily implementable tool for clinicians in evaluating suspicious skin lesions,” concluded the researchers.

Yosipovitch said the findings are important because skin cancer is the most common cancer in the U.S., with more than 3.5 million nonmelanoma skin cancers diagnosed in 2 million people annually.

“Patients sometimes have multiple lesions that are suspicious looking, and those that are itchy or painful should raise high concerns for nonmelanoma skin cancers,” he said.

After undergoing a skin biopsy, the patients in the study were asked to complete a numerical ranking scale—called a visual analog scale—to quantify the intensity of itch and pain associated with their skin lesion. The scale went from zero (no sensation) to 10 (the most intense sensation).

When the researchers compared the patients’ responses, they found that:

The prevalence of itch was greatest in squamous cell carcinoma (46.6 percent), followed by basal cell carcinoma (31.9) and melanoma (14.8).

Pain frequency was greatest in squamous cell carcinoma (42.5 percent), followed by basal cell carcinoma (19.9) and melanoma (3.7).

Pain and itch often went hand in hand: 45.6 percent of lesions associated with itch also had pain; and 60 percent of painful lesions also involved itch.

The most painful lesions tended to be those with the greatest depth (except for melanoma lesions, which did not correlate with pain). Pain and itch also were associated with lesions larger in diameter. Cancers that were ulcerated (sores or open wounds) tended to be associated with pain but not with itch.

Pain itch or both were likelier to be present when the laboratory analysis of the skin lesion sample suggested a marked or moderate degree of inflammation as compared to mild or no inflammation.

Yosipovitch said he hopes the study findings will prompt dermatologists to incorporate the use of a ranking scale for pain and itch when evaluating patients with suspicious skin lesions.

“This could increase the detection of cancerous skin lesions,” he said.