Current Perspectives Among US Dermatologists on Chemoprevention of Nonmelanoma Skin Cancer: A Survey-Based Study

Introduction: Nonmelanoma skin cancer (NMSC) is the most common malignancy in the US Primary prevention of NMSC with physical photoprotective measures are often not sufficient to impact skin cancer incidence in high-risk individuals. Chemoprevention is the use of agents to prevent, suppress, and reverse carcinogenic progression. Many agents have been investigated, but preclinical and clinical studies are often inconsistent. Methods: A cross-sectional study was designed to assess current practices, perceptions, and general knowledge of U.S. dermatologists pertaining to chemopreventive strategies. This voluntary online survey was distributed to practicing dermatologists via dermatology society electronic mailing lists. Software from SurveyGizmo.com was used for survey implementation and anonymous data collection. Stata 12.0 statistical analysis software (StataCorp, LP) was used to perform nonparametric Spearman correlation tests. Results: Approximately half of the 156 responding dermatologists reported being in practice 16 years or more (47.3%) and working in urban communities (48.7%). 59.3% reported "frequently" using topical therapies, while only 13.7% reported frequent use of systemic chemopreventive therapies. Dermatologists practicing in urban settings were more likely to indicate they believe knowledge has increased substantially (P=0.047) as compared to colleagues in other communities. Respondents also reported varying degrees of confidence in selecting appropriate chemopreventive regimens: most feel comfortable determining which agents to use in patients, but 29.1% answered "neutral" or "disagree" when asked if they felt comfortable. More experienced dermatologists were more likely to recommend diet modifications such as increased dietary vitamin D (P=0.014), low fat diet (P=0.022), and tea polyphenols (P=0.04) as methods of chemoprevention. Discussion: Efforts to identify effective, minimally-toxic chemopreventive agents have long been underway, but conflicting reports in the literature make formulation of validated guidelines challenging. Our study suggests differing perceptions, comfort levels, and practice strategies among U.S. dermatologists. This serves to identify areas of research requiring additional contributions from clinical investigators and reveals a need to broaden understanding of available evidence-based techniques.