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Itching and Pain Associated with Skin Cancer

According to new research from Temple University in Philadelphia, skin lesions that are itchy and painful may be indicators that the area is cancerous. The study, recently published in JAMA Dermatology, used a simple bedside evaluation of itch and pain for suspicious skin lesions. 

Researchers examined 268 patients, representing 339 laboratory-confirmed skin cancer lesions, at Wake Forest University Baptist Center in North Carolina. Using an 11-point scale (scores 0-10), participants completed questionnaires that assessed the itch and pain intensity of their tumor at the time of their excision. 

Of the skin cancer subtypes represented in the analysis (166 basal cell carcinomas, 146 squamous cell carcinomas, and 27 melanomas), approximately 37% of all the participants’ skin cancer lesions were accompanied by itching, and 28.2% involved pain, though itching and painful symptoms were mostly absent in melanomas. Itch intensity was significantly associated with the degree of inflammation.

The study’s lead author and chairman of the department of dermatology at Temple, Dr. Gil Yosipovitch, noted that lesions that are aggressively painful or itchy might indicate a more aggressive form of cancer. Itching is caused by nerve fibers in the upper layers of skin, while pain can be caused by deeply penetrating, ulcer forming carcinomas. Researchers theorized that itching emanates from the upper layers of the skin, whereas pain is associated with deeper processes. 

“If [a healthcare provider] suspects a lesion is cancerous, [he/she should] ask these questions,” Yosipovitch says. “It’s not a sophisticated device, just a simple question that gives you additional information and would be confirmed by histology.” Furthermore, the study’s authors suggests these findings could be helpful in a number of clinical-setting scenarios, such as allowing dermatology providers to be more focused on lesions that are itchy or painful, particularly when they are treating older patients with many skin lesions or transplant patients who are susceptible to skin cancer. 

As Yosipovitch suggests, the findings should not be a replacement for other diagnostic tests, but the study shows that a simple bedside assessment for the presence and intensity of pain or itch is an easily implementable tool for evaluating suspicious skin lesions.  

Sources: 1, 2

Image: Mario Klingemann

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