Dental hygienist and therapist Annette Matthews talks about the window of opportunity for dental nurses to talk to patients about sun, skin and the power of protection

Despite the vast majority of all skin cancers being preventable, statistics continue to soar and ignorance regarding how to spot the early signs and symptoms on a personal level, or within professional capacities, remains widespread.

The MASCED PRO is an online training programme that has been developed by national melanoma and skin cancer awareness charity, Skcin, to provide medical and healthcare practitioners with an accessible, cost-effective tool. With this, they develop their knowledge of the early signs and symptoms of melanoma and non-melanoma skin cancers, giving them the confidence to refer or signpost patients to appropriate colleagues and/or services following the identification of suspicious lesions.

The objective of the MASCED PRO programme is to fill the mammoth void that exists in this arena by facilitating the provision of effective training tools with quality printed and online resources. It enables practitioners to integrate this knowledge into their everyday practice, and extend vital information on prevention and early detection across their patient communities.

The training programme has been reviewed and is supported by the British Association of Dermatologists, the British Association Skin Cancer Specialist Nurses and the British Dermatological Nursing Group and endorsed by The College of Podiatry.

According to Public Health England: ‘Allied health professionals have a major role to play in prevention.’ It recently published the first ever UK-wide public health strategy that sets out their plans to maximise the contribution that Allied Health Professionals make to prevention and how they can deliver public health benefits. Indeed, AHPs are the third largest workforce in the NHS.

'Spending time with millions of people across the country every day, these professionals are well placed to offer skin health advice and support to a wide range of different communities.'

Marie Tudor is CEO of Skcin, the skin cancer charity that raises awareness of the UK’s most common cancer through education, prevention and early detection. She suggests: ‘Supporting all healthcare professionals to embed prevention and early detection within their practice is critical to reducing the soaring rates of skin cancer in the UK.

'The MASCED PRO training programme strongly supports the call by Public Health England to look beyond the obvious NHS workforce to see how other professionals can help prevent illness and promote wellbeing.’

Looking for support

Dental hygienist and therapist Annette Matthews is an ambassador of Skcin. Here, she reveals why she is a strong supporter of the charity, its programme and the work that it hopes to achieve…

Do you believe a dental check up is a valuable opportunity for skin cancer screening? I was one month out of dental school when I spotted my first basal cell carcinoma on a patient’s nose. That same month, I also found a squamous cell carcinoma during a direct access appointment.

It is vitally important that we know what to recognise, as we have a limited window of opportunity. We see patients regularly and build rapport and it is possible that we may spot warning signs early on.

Do you believe the dental team is perfectly placed to identify signs and symptoms? From the moment a patient enters the practice, we should all take responsibility for our roles.

Our reception staff do a fabulous job and can chat about risk factors (holidays in sunny climates and the rest) without even thinking about it. They too have rapport with the patient and could take note of any changes and highlight it to the patient. Having a subliminal message dotted around the surgeries about safe sun and SPF is the way forward.

I worked as a dental nurse prior to going to university and had so many occasions when I saw things I didn’t think looked right. I would look up to my dentist to hope they had seen it too and sometimes nothing was said.

As a 19 year old, I didn’t have the confidence to speak up. I dread to think of this still happening and feel the MASCED PRO training will give every single member of the team the confidence to speak up and note things that do not look right for our patients.

Do you think checks could be incorporated into the mouth, head and neck screening that is carried out in routine oral health screening? We do external tissue checks amongst other soft tissue notations in our daily practice. I do this even when seeing patients under a referral. This is not because I doubt competence, but rather I do believe that two sets of eyes and ears are always better than one.

If my dental nurse noted something I hadn’t, I would be grateful to her pointing this out – so too would the patient. I always make a note of anything suspicious – be it on the skin or in and around the mouth.

My notes contain my observations onbacks of ears, necks, top of heads and hands, as well as the oral cavity. Quite frankly, anything I can see when I have the patient with me.

How can dental nurses get involved with the MASCED PRO training programme? Quite simply, the whole team needs to register and get involved. You can become a ‘fully accredited clinic’ for a matter of pounds and support an amazing initiative in the process.

The MASCED PRO training is an incredible tool. It raises awareness and indeed confidence around skin cancer and melanoma detection. You are not diagnosing and you are not responsible for this, but what you are is another window of opportunity to spot it and make a difference.

The short online course consists of a little reading and learning and then an online test with some images of lesions to recognise and think about. I know time in surgeries is limited and I know you guys run around like headless chickens but taking a little time out at the practice to complete this would be the best thing you can do today.

In fact, take this article and show it the principal or practice manager and tell them Annette said we have to do this – with a big smile! In all seriousness, what practice would NOT want to be at the forefront of this growing epidemic and educating and detecting potentially deadly lesions and growths.

How important is collaboration between health professionals regarding skin cancer prevention? This is essential. I have occasionswhere a GP and a GDP have referred the patient back to me and I have asked for it to be reconsidered and sent on for investigation, later transpiring it to be positive diagnosis.

This is no criticism of those busy GPs and GDPs who work tirelessly but they can allow us to be their eyes and ears! This training will create more awareness and increase survival by way of early detection.

How do you advise teams to start the conversation with patients about their lifestyle habits?

In my surgery, I have sun protection factor cream and interdental cleaning aids side by side. I have an opportunity to prevent damage – to skin or smiles and I certainly will use that opportunity to do so.

Patients often tell us about their holidays and talk to us about their ailments, so how is this different?

Product placement and posters and, of course, the MASCED PRO accreditation certificates on display for all to see will enable patients to understand and embrace the connection.

Free toothpaste samples and free SPF samples could be a great starting point and working with some skincare brands could be a way to grow your practice and indeed your patient services.

Sun damage and cancers – should dental nurses be thinking about their own health? Absolutely! I used to be an avid sunbed user and, as a dental nurse, this was even worse. On my lunch hour, I would sneak off for a 20-minute power nap on the local ‘safe tanning’ sunbed. Now I know what I know this makes me feel a little ill.

We can feel and think we are invincible but the fact is we are not. I have some amazing chemical free/toxin free false tan I apply routinely now as I totally get it – I hate winter, too.

However, we only have one life and the skin is a very sensitive organ – we need to look after it!

Top tips for a thorough self-examination An ideal time to check your skin is after a bath or shower. Make sure you check your skin in a room with plenty of light. Use a full-length mirror and a hand-held mirror. Check yourself thoroughly from head to toe: Look at your face, neck, ears, and scalp. When checking your scalp use a comb or a hairdryer to move your hair so that you can see better, or ask a relative or friend to check through your hair as it can be hard to check by yourself. Look at the front and back of your body in the mirror. Again asking someone to help you check hard to see areas like your back can be helpful. Make sure you thoroughly check your entire body. Remember to raise your arms and check your left and right sides. Remember to check the following areas where signs and symptoms can go unnoticed: Fingernails, and the palms of your hands. The genital area, between your buttocks and under breasts. Your feet, including your toenails, your soles, and the spaces between your toes. Basic warning signs to detect A growth that increases in size and appears pearly, translucent, tan, brown, black, or multi-coloured. A mole (that looks different from your other moles). A mole, birthmark, beauty mark, or any brown spot that: Varies in colour. Increases in size or thickness. Changes in texture. Is irregular in outline. Is bigger than 6mm or the size of a pencil eraser. Appears after age 21. A new red or darker colour flaky patch that may be a little raised. A new flesh-coloured firm bump. An open sore that doesn’t heal. A spot or sore that continues to itch, hurt, crust, scab, erode, or bleed.

Marie Tudor is CEO of Skcin. She says: ‘Our work is solely dedicated to raising awareness of skin cancer, promoting early detection and sun safety and all our work underpins activity around this goal. The shocking rising statistics of skin cancer speak for themselves. With a 45% increase in cases over the past decade, we need to act now. Skcin’s work is strategic in its approach to combat these statistics via educational intervention. Our training provides a quality endorsed and accessible solution to the gap in education across all sectors. Our goal is to work with all healthcare professionals because they all have a vital role to play in the prevention and early detection of skin cancer via their regular interactions with patients and work in the community. Skcin is looking forward to working with the dental sector and working with stakeholders to achieve this. 'The training costs £40 with all funds received ploughed straight back into the charity, enabling us to enhance and develop our comprehensive range of educational intervention programmes and resources, to aid the prevention and early detection of melanoma and skin cancer on a national scale.' For further information, call 0777 5771986, email marie.tudor@skcin.org or visit www.skcin.org

Sun Awareness Week 4-10 May The British Association of Dermatologists (BAD) currently runs a national campaign around skin cancer called Sun Awareness, which includes national Sun Awareness Week in May. Sun Awareness is the British Association of Dermatologists’ annual campaign to raise awareness of skin cancer. The campaign is two-pronged and combines prevention and detection advice. The first aim is to encourage people to regularly self-examine for skin cancer. The second is to teach people about the dangers of sunburn and excessive tanning, and to discourage people from using sunbeds, in light of the associated risks of skin cancer. In addition to public education about the dangers of sunbed use, the BAD has also been involved in campaigning for legislation to regulate the sunbed industry and is continuing to push towards further and improved regulation. For more information visit www.bad.org.uk

Author: Annette Matthews