Pain, itching could signal presence of skin cancer

Results of a new study suggest pain and itching can be an indication of skin cancer.

The study was led by Gil Yosipovitch, M.D., chairman of the department of dermatology at the Temple University School of Medicine, Philadelphia. The research team examined the correlation between pain and itch and histologic features of skin cancers in patients diagnosed with a variety of cutaneous neoplasms, including basal cell and squamous cell carcinomas and melanomas. The study involved 268 patients at Wake Forest University Baptist Medical Center, who had 339 laboratory-confirmed skin cancer lesions from July 2010 to March 2011.

“The most significant findings of this study for dermatologists and their patients is that, of the cases we analyzed, nearly 40 percent of skin cancer lesions were accompanied by itching, and nearly 30 percent involved pain,” Dr. Yosipovitch tells Dermatology Times. “Nonmelanoma skin cancers - specifically, basal cell carcinoma and squamous cell carcinoma - are more likely than melanoma to involve itch or pain. Pain is more common in squamous cell carcinoma.”

Next: In what types of skin cancer was itch most prevalent?

Other findings:

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

• Pain prevalence was greatest in squamous cell carcinoma (42.5 percent), followed by basal cell carcinoma (19.9 percent) and melanoma (3.7 percent);

• More than 45 percent of lesions associated with itch also had pain, while 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 was also associated with larger lesions. Ulcerated cancers tended to be associated with pain but not itching.

Dr. Yosipovitch says the study’s results are evidence that “a simple bedside evaluation for the presence and intensity of pain or itch” can be an efficient, effective tool for evaluating suspicious skin lesions.

“Patients sometimes have multiple lesions that are suspicious looking, and those that are itchy or painful should raise higher concerns for nonmelanoma skin cancers,” he says. “My hope is that these study findings will prompt dermatologists to incorporate the use of a ranking scale for pain and itch when evaluating patients with suspicious skin lesions. I believe this could increase the detection of skin lesions that are cancerous.”

The study was published online July 23 in JAMA Dermatology.

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