Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain

Main Article Content


Sunscreening Agents, Skin Neoplasms, Early Detection of Cancer, Pharmacies, Pharmacists, Cross-Sectional Studies, Spain


Background: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access.

Objective: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users.

Methods: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer.

Results: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended.

Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening.


Download data is not yet available.
Abstract 1116 | pdf Downloads 475 online appendix Downloads 0


1. Marks R. An overview of skin cancers. Cancer. 1995;75(2 Suppl):607-612.;2-8
2 Trakatelli M, Ulrich C, del Marmol V, Euvrard S, Stockfleth E, Abeni D. Epidemiology of nonmelanoma skin cancer (NMSC) in Europe: accurate and comparable data are needed for effective public health monitoring and interventions. Br J Dermatol. 2007;156(Suppl 3):1-7.
3 Lucas R, McMichael T, Smith W, Armstrong B. Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation. Geneva, World Health Organization. Available at: (accessed on Aug 24, 2017).
4 Font Izquierdo À, Marcos-Gragera R, Vilardell Gil L, et al. CanGir: El càncer a Girona. Available at: (accessed on Aug 24, 2017).
5 Housman TS, Feldman SR, Williford PM, Fleischer AB Jr, Goldman ND, Acostamadiedo JM, Chen GJ. Skin cancer is among the most costly of all cancers to treat for the Medicare population. J Am Acad Dermatol. 2003;48(3):425-429.
6 Eriksson T, Tinghög G. Societal cost of skin cancer in Sweden in 2011. Acta Derm Venereol. 2015;95(3):347-348.
7 John SM, Trakatelli M, Gehring R, Finlay K, Fionda C, Wittlich M, Augustin M, Hilpert G, Barroso Dias JM, Ulrich C, Pellacani G. CONSENSUS REPORT: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease - A Call to Action. J Eur Acad Dermatol Venereol. 2016;30(Suppl 3):38-45.
8 Stang A, Stausberg J, Boedeker W, Kerek-Bodden H, Jöckel KH. Nationwide hospitalization costs of skin melanoma and non-melanoma skin cancer in Germany. J Eur Acad Dermatol Venereol. 2008;22(1):65-72.
9 Puig S1, Marcoval J, Paradelo C, Azon A, Bartralot R, Bel S, et al. Melanoma incidence increases in the elderly of catalonia but not in the younger population: effect of prevention or consequence of immigration? Acta Derm Venereol. 2015;95(4):422-426.
10 Departament de Salut. Pla Director d’Oncologia de Catalunya - Melanoma de Pell. Available at: (accessed on Aug 24, 2017).
11 Carli P, De Giorgi V, Nardini P, Mannone F, Palli D, Giannotti B. Melanoma detection rate and concordance between self-skin examination and clinical evaluation in patients attending a pigmented lesion clinic in Italy. Br J Dermatol. 2002;146(2):261-266.
12 Carli P, De Giorgi V, Giannotti B, Seidenari S, Pellacani G, Peris K, Piccolo D, Rubegni P, Andreassi L. Skin cancer day in Italy: method of referral to open access clinics and tumor prevalence in the examined population. Eur J Dermatol. 2003;13(1):76-79.
13 Hoorens I, Vossaert K, Pil L, Boone B, De Schepper S, Ongenae K, Annemans L, Chevolet I, Brochez L. Total-body examination vs lesion-directed skin cancer screening. JAMA Dermatol. 2016;152(1):27-34.
14 Waldmann A, Nolte S, Weinstock MA, Breitbart EW, Eisemann N, Geller AC, Greinert R, Volkmer B, Katalinic A. Skin cancer screening participation and impact on melanoma incidence in Germany – an observational study on incidence trends in regions with and without population-based screening. Br J Cancer. 2012;106(5):970-974.
15 Breitbart EW, Waldmann A, Nolte S, Capellaro M, Greinert R, Volkmer B, Katalinic A. Systematic skin cancer screening in Northern Germany. J Am Acad Dermatol. 2012;66(2):201-211.
16 Bruguera M. Tiempo razonable para la visita médica. La Vanguard. Available at: (accessed on Aug 24, 2017).
17 Salas D, Cuevas D, Málaga A, et al. Guía de Prevención y Tratamiento del Melanoma. Available at:ÓN-Y-TRATAMIENTO-DEL-MELANOMA-CONSELLERIA-DE-SANITAT.pdf (accessed on Aug 24, 2017).
18 Watts CG, Dieng M, Morton RL, Mann GJ, Menzies SW, Cust AE. Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: A systematic review. Br J Dermatol. 2015;172(1):33-47.
19 Argenziano G, Giacomel J, Zalaudek I, Apalla Z, Blum A, De Simone P, Lallas A, Longo C, Moscarella E, Tiodorovic-Zivkovic D, Tiodorovic J, Jovanovic DL, Kittler H. Twenty nevi on the arms: a simple rule to identify patients younger than 50 years of age at higher risk for melanoma. Eur J Cancer Prev. 2014;23(5):458-463.
20 Buettner PG, Garbe C. Agreement between self-assessment of melanocytic nevi by patients and dermatologic examination. Am J Epidemiol. 2000;151(1):72-77.
21 Little P, Keefe M, White J. Self screening for risk of melanoma: validity of self mole counting by patients in a single general practice. BMJ. 1995;310(6984):912-916.
22 Paddock LE, Lu SE, Bandera EV, Rhoads GG, Fine J, Paine S, Barnhill R, Berwick M. Skin self-examination and long-term melanoma survival. Melanoma Res. 2016;26(4):401-408.
23 Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Bastholt L, Grob JJ, Malvehy J, Newton-Bishop J, Stratigos AJ, Pehamberger H, Eggermont AM; European Dermatology Forum (EDF); European Association of Dermato-Oncology (EADO); European Organisation for Research and Treatment of Cancer (EORTC). Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - Update 2016. Eur J Cancer. 2016;63:201-217.
24 Fiessler C, Pfahlberg A, Li J, Uter W, Gefeller O. Accuracy and reliability of naevus self-counts. Melanoma Res. 2014;24(6):611-616.
25 Quintero E1, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366(8):697-706.
26 Burón A, Grau J, Andreu M, Augé JM, Guayta-Escolies R, Barau M, Macià F, Castells A; en nombre del Grupo PROCOLON. [Colorectal Cancer Early Screening Program of Barcelona, Spain: Indicators of the first round of a program with participation of community pharmacies]. Med Clin (Barc). 2015;145(4):141-146.
27 Havlicek AJ, Mansell H. The community pharmacist’s role in cancer screening and prevention. Can Pharm J (Ott). 2016;149(5):274-282.
28 Collins BC, Bronson HW, Martin EG. Assessing the efficacy and feasibility of a retail pharmacy-based HIV testing program. In: CROI Conference. Seattle, 2017.
29 Guayta-Escolies R, Giménez A, Rifà B, Barau M, Gascón P, Dronda A, Martínez JL. [HIV/AIDS screening in community pharmacies]. Gac Sanit. 2014;28(3):253-254.
30 Bonafonte MÁ, Boleda X, Ricote M. [The use of the Streptotest in community pharmacies for the rapid determination of bacterial and viral pharyngitis in adult patients]. Farm Comun 2013;5:59-63.
31 Mayer JA, Eckhardt L, Stepanski BM, Sallis JF, Elder JP, Slymen DJ, Creech L, Graf G, Palmer RC, Rosenberg C, Souvignier ST. Promoting skin cancer prevention counseling by pharmacists. Am J Public Health. 1998;88(7):1096-1099.
32 Mayer JA, Slymen DJ, Eckhardt L, Rosenberg C, Stepanski BM, Creech L, Palmer RC, Elder JP, Graf G, Anderson ST. Skin cancer prevention counseling by pharmacists: specific outcomes of an intervention trial. Cancer Detect Prev. 1998;22(4):367-375.
33 Armstrong EP, Campbell C, Van Allen A, Vincent E. Skin Cancer Knowledge and Prevention Counseling Among Arizona Pharmacists. J Pharm Pract. 2010;23(4):358-366.
34 Consejo General de Colegios Oficiales de Farmacéuticos. [Public health: Campaings of summer care]. Portalfarma. Available at: (accessed on Aug 25, 2017].
35 Bosch N, Rodríguez-Caba C, López R, et al. Campaña ‘Sol i Salut’: Encuesta sobre hábitos y conocimientos frente al riesgo solar. 2013.
36 Fariñas-Álvarez C, Ródenas JM, Herranz MT, Delgado-Rodríguez M. The naevus count on the arms as a predictor of the number of melanocytic naevi on the whole body. Br J Dermatol. 1999;140(3):457-462.
37 Likert R. A technique for the measurement of attitudes. Arch Psychol 1932;22:55.
38 Col·legi de Farmacèutics de Barcelona. Els impagaments i la campanya contra el càncer de pell, entre els temes més destacats als mitjans de comunicació. Blog COFB. Available at: (accessed on Aug 24, 2017).
39 Souvignier ST, Mayer JA, Eckhardt L. Educating the public about skin cancer prevention: a role for pharmacists. J Clin Pharm Ther. 1996;21(6):399-406.
40 Watson N. Spotchecks to stay ahead of the game [WWW Document]. Pharm. Guild Aust. Available at: (accessed on Aug 24, 2017).
41 Kjome RLS, Wright DJ, Bjaaen AB, Garstad KW, Valeur M. Dermatological cancer screening: Evaluation of a new community pharmacy service. Res Social Adm Pharm. 2017;13(6):1214-1217.
42 Boseley S. Doctors wary as pharmacies cash in on minor check-ups and treatments. Guard. Available at: (accessed on Aug 24, 2017).
43 The Boots Company PLC. Innovative Mole Scanning Service available at Boots UK Raises Awareness of Rising Skin Cancer Threat Amongst Young People. Available at: (accessed on Aug 24, 2017).
44 Börve A, Dahlén Gyllencreutz J, Terstappen K, Johansson Backman E, Aldenbratt A, Danielsson M, Gillstedt M, Sandberg C, Paoli J. Smartphone teledermoscopy referrals: A novel process for improved triage of skin cancer patients. Acta Derm Venereol. 2015;95(2):186-190.
45 Moreno-Ramírez D, Ferrandiz L, Nieto-García A, Carrasco R, Moreno-Alvarez P, Galdeano R, Bidegain E, Rios-Martin JJ, Camacho FM. Store-and-Forward Teledermatology in Skin Cancer Triage: Experience and Evaluation of 2009 Teleconsultations. Arch Dermatol. 2007;143(4):479-484.
46 Spinks J, Janda M, Soyer HP, Whitty JA. preferences for teledermoscopy screening to detect melanoma early. J Telemed Telecare. 2016;22(1):39-46.
47 Moffat C. Pharmacy skin cancer checks ‘irresponsible’. AMA. Available at: (accessed on Aug 24, 2017).
48 Haggan M. Spotcheck to help spot trouble early. Available at: (accessed on Aug 24, 2017).
49 Desloires V. Doctors disapprove of pharmacy skin cancer checks. Sydney Morning Her. Available at: (accessed on Aug 24, 2017).
50 Maguire-Eisen M. Risk assessment and early detection of skin cancers. Semin Oncol Nurs. 2003;19(1):43-51.
51 Arundell FD. Screening for Melanoma and Skin Cancer. JAMA. 1986;255(18):2443-2444.
52 Burón A, Posso M, Sivilla J, Grau J, Guayta R, Castells X, Castells A, Macià F; en nombre del Grupo Procolon. Analysis of participant satisfaction in the Barcelona colorectal cancer screening programme: Positive evaluation of the community pharmacy. Gastroenterol Hepatol. 2017;40(4):265-275.
53 Alvarez-Urturi C, Andreu M, Hernandez C, Perez-Riquelme F, Carballo F, Ono A, et al. Impact of age- and gender-specific cut-off values for the fecal immunochemical test for hemoglobin in colorectal cancer screening. Dig Liver Dis. 2016;48(5):542-551.
54 Fornos-Pérez JA, Andrés-Rodríguez NF, Andrés-Iglesias JC, Luna-Cano R, García-Soidán J, Lorenzo-Veiga B, Mera-Gallego R, García-Riestra R. Detección de personas en riesfo de padecer diabetes en farmacias comunitarias de Pontevedra (DEDIPO). Endocrinol Nutr. 2016;63(8):387-396.
55 Gascón P, Rius P, Guayta-Escolies R, et al. Evolució de la presentació de serveis d’atenció farmacèutica i serveis relacionats amb la salut comunitària a les farmàcies de Catalunya 2012-2017. Available at: (accessed on Aug 24, 2017).
56 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41(1):28-44.
57 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: II. Sun exposure. Eur J Cancer. 2005;41(1):45-60.
58 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Zanetti R, Masini C, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer. 2005;41(14):2040-2059.
59 Shin TM, Shaikh WR, Etzkorn JR, Sobanko JF, Margolis DJ, Gelfand JM, Chu EY, Elenitsas R, Miller CJ. Clinical and pathologic factors associated with subclinical spread of invasive melanoma. J Am Acad Dermatol. 2017;76(4):714-721.
60 Pampena R, Kyrgidis A, Lallas A, Moscarella E, Argenziano G, Longo C. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications. J Am Acad Dermatol. 2017;77(5):938-945.
61 Wu YP, Kohlmann W, Curtin K, Yu Z, Hanson HA, Hashibe M, Parsons BG, Wong J, Schiffman JD, Grossman D, Leachman SA. Melanoma risk assessment based on relatives’ age at diagnosis. Cancer Causes Control. 2018;29(2):193-199.
62 Stratigos AJ, Fargnoli MC, De Nicolo A, Peris K, Puig S, Soura E, Menin C, Calista D, Ghiorzo P, Mandala M, Massi D, Rodolfo M, Del Regno L, Stefanaki I, Gogas H, Bataille V, Tucker MA, Whiteman D, Nagore E, Landi MT. ΜelanoQ: A Consensus Questionnaire of Standardized Epidemiologic and Clinical Variables for Melanoma Risk Assessment by the MelaNostrum Consortium. J Eur Acad Dermatol Venereol. 2018;32(12):2134-2141.
63 Academia Española de Dermatología y Venereología, Fundación Piel Sana, Cinfasalud. IV Estudio Cinfasalud: Percepción y hábitos de salud de la población española en torno a la fotoprotección. Available at:ábitos-Fotoproteccion-Junio-2016.pdf (accessed on Aug 24, 2017).
64 del Boz J, Fernández-Morano T, Padilla-España L, Aguilar-Bernier M, Rivas-Ruiz F, de Troya-Martín M. Skin cancer prevention and detection campaign at golf courses on Spain’s Costa del Sol. Actas Dermosifiliogr. 2015;106(1):51-60.
65 Argenziano G, Zalaudek I, Hofmann-Wellenhof R, Bakos RM, Bergman W, Blum A, et al. Total body skin examination for skin cancer screening in patients with focused symptoms. J Am Acad Dermatol. 2012;66(2):212-219.
66 Lee G, Massa MC, Welykyj S, Choo J, Greaney V. Yield from total skin examination and effectiveness of skin cancer awareness program. Findings in 874 new dermatology patients. Cancer. 1991;67(1):202-205.;2-h
67 Aldridge R, Naysmith L, Ooi ET, Murray CS, Rees JL. The importance of a full clinical examination: assessment of index lesions referred to a skin cancer clinic without a total body skin examination would miss one in three melanomas. Acta Derm Venereol. 2013;93(6):689-692.
68 Fartasch M, Diepgen TL, Schmitt J, Drexler H. The relationship between occupational sun exposure and non-melanoma skin cancer: clinical basics, epidemiology, occupational disease evaluation, and prevention. Dtsch Arztebl Int. 2012;109(43):715-720.