Experts seek more skin training units in Philippine countryside

By Patricia B. Mirasol, Reporter

MORE training institutions in dermatology are needed outside the Philippine capital to meet the skin health concerns of Filipinos in the countryside, according to a skin expert.

There are 1,275 board-certified dermatologists serving 109 million Filipinos, according to the Philippine Dermatological Society (PDS). About 50% are in Metro Manila.

“We have few in the provinces, mostly affiliated with the Department of Health (DoH),” said Cynthia P. Ciriaco-Tan, a dermatologist and president of PDS.

“Trainees in the provinces have to be bound by a ‘return of service agreement,’ requiring them to serve in their region for at least one year after graduation to ensure a steady supply of certified dermatologists in the area,” she said in an April 16 e-mail.

PDS’s Board of Accreditation is looking closely at the agreement in coordination with DoH, she added.

“The DoH strongly encourages the establishment of training programs outside Metro Manila in preparation for universal health coverage,” she added.

Although the Philippines scores low in certain illnesses such as skin cancer, this lowered risk is offset by factors such as socioeconomic status and a low dermatologist-patient ratio.

Derma.Plus, a Germany-based medical research group, ranked the Philippines 55^th out of 62 countries in skin cancer susceptibility. Its index “analyzes the ultraviolet factor, the skin tone by demographic percentages and rate of incidences from a range of countries to identify geographically where the highest rates of skin cancer are most likely to occur.”

The skin pigment melanin has been known to have a protective role against UV damage in human skin. A June 2022 publication, however, said the inherent photoprotection that lowers the risk for Asians is offset by other factors.

In the Philippines, more than 34% of Filipinos are in agriculture, forestry, fishing and construction, where outdoor labor is the norm, the JAAD International study pointed out. Because of the lack of skincare specialists outside Metro Manila, Filipinos with suspicious lesions end up having them checked at community health centers, increasing the risk for misdiagnosis.

About 2,700 Filipinos have had skin cancers since 2011, based on data from PDS.

UV radiation exposure from the sun plays a big role in the pathogenesis of the most common skin cancers, according to dermatologist Joshua A. Arcaira.

“Those with more frequent and longer exposures to the sun are most at risk — such as those in the agriculture industry,” he said in a Facebook Messenger chat.

Skin cancers are the “ugly ducklings” on your skin, said Mr. Arcaira.

“When you notice a bump that has been growing quite fast (weeks to months) or easily bleeds, a change in skin color (black, brown, blue, purple), a wound that doesn’t seem to heal, or a new mole that wasn’t there before, it is best to have it checked by your friendly board-certified dermatologist,” he said.

Ms. Tan said Filipinos are slowly getting aware of the signs of skin cancer.

“PDS is actively promoting public education. There is a National Skin Cancer Awareness Week that hospitals usually advocate,” she said.

The most common types of skin cancer in the country, which are also the most common types worldwide, are basal cell and squamous cell carcinomas.

The two are non-melanoma skin cancers, Ms. Tan said. They “present themselves as indolent papules (bumps on the skin) or plaques (lesions that may result from a combination of papules) which bleed easily or do not heal completely,” she said.

Because a skin cancer registry has not yet been established in the Philippines, there are no data on the exact numbers, Mr. Arcaira said.

“The real numbers are most likely underestimated, since not everyone has the means or opportunity to seek consultations with skin specialists,” he told BusinessWorld.

Preventive measures include daily use of a broad-spectrum sunscreen that’s at least SPF 30 and PA+++, avoidance of sun exposure from 10 a.m. to 2 p.m. and the use of protective clothing such as wide-brimmed hats, sunglasses and long-sleeved shirts.

“Most skin cancers can be treated completely especially if caught early, so please have suspicious bumps checked as soon as possible. Treatment becomes complicated if we wait too late and the tumor gets bigger,” he added.