Health professionals have for many years sought to call attention to a form of cancer that, unlike most others, is hidden in plain sight – on the skin. Now a cadre of specially trained professionals that includes hairstylists and barbers is helping to identify suspicious lesions.

The initiative comes from Karen Pierce-Stewart, executive director of the Cancer Care Center of York County in South Sanford, who launched the Skinny on Skin program two years ago to train hairstylists to look for early signs of skin cancer. Since its founding, the program has graduated more than 100.

“After all, they actually know our scalp better than we do,” Pierce-Stewart said. The trainees have since expanded to include barbers, physical therapists and massage therapists.

The Cancer Care Center is a collaborative effort between MaineHealth in Portland and Southern Maine Health Care that operates independently. While the primary function of the Sanford clinic is radiation therapy, Pierce-Stewart’s job includes a generous dose of public outreach.

The notion of training professionals who handle clients’ skin came up during a brainstorming session with a group of medical students from the University of New England. Skin cancer is one of the most prevalent forms of the disease – and also one of the most treatable, if caught early. Each year, more than three million Americans are diagnosed with non-melanomic skin cancer, and New England has some of the highest rates in the U.S.

Christy Legere, who with her sister, Kelly Clark, owns Magnolia’s Salon in Sanford, was among the first to be trained; six of the 15 stylists in her salon have now taken the course. Legere said that previously, she sometimes noticed a suspicious spot or mole, “but I didn’t feel comfortable saying anything, because I didn’t really know.” Following the training, she has no hesitation about speaking up. “I can’t offer a diagnosis, but I can say ‘this is something you might want to have checked.’ ”

This hasn’t produced any awkward moments, she said. “I’ll often hear, ‘I was going to the doctor anyway, but thanks for telling me.’ ”

The salon sees about 1,200 customers over the course of a year, many of whom come to the salon every three to six weeks. One of the first beneficiaries of the program was Legere herself, who was treated for a cancerous lesion. Pierce-Stewart, too, identified a cancerous area through self-examination.

There are standard methods of self-examination, available online and in YouTube videos, plus a series of prevention tips (See “How to avoid skin cancer,” page T12).

But getting people to focus on the issue is the essential first step, said Pierce-Stewart. Early detection is particularly important for melanoma, which is relatively rare but causes most of the 10,000 skin cancer deaths annually in the U.S. – many of those diagnosed are still in their 20s.

With the help of students and interns from UNE, the program has now reached more than 5,000 students in York and Cumberland county schools, who may be some of the best ambassadors when they talk to their parents and other adults.

“Kids are more aware of the dangers. They’ve usually heard about them already,” Pierce-Stewart said. It’s older Mainers, many from the “baby-oil-at-the-beach generation” who may have experienced the most sun damage, and are the most likely to have precancerous skin, she said.


Reaching some of those adults is the aim of the latest innovative effort – bringing a blacklight screening machine to Portsmouth International Airport, at the old Pease Air Force Base site. The main building is relatively small, and most of the passengers are boarding direct flights to Florida – an ideal audience, Pierce-Stewart said.

The first outing was in early February. UNE graduate student Meghan Morash said of 100 or so travelers, about a quarter came over to talk.

“When people are waiting, they’re looking for something to do, and their kids are often the first ones to ask what we’re there for,” she said. “Not everyone tried out the skin analysis machine, but we handed out lots of sunscreen – the travel size that you can take on board.”

The blacklight illumination the machine provides is a good indicator of problem spots, she said – and children are naturally curious about trying it out on themselves, and their parents.

Morash had also done many school presentations, and middle school and high school health classes provide some of the best venues. “They have such great questions, and for them it’s not as scary as it is for adults,” she said. “You can tell them that sunlight immediately starts to affect our DNA, but that it’s not a terrible thing.” And then you can say, “If you see anything big and splotchy in the blacklight, you might want to check that out.”

The reason New England has higher skin cancer rates has prompted much conjecture.

“It may because we’re outdoors a lot in times when we don’t think of the sun,” Pierce-Stewart said, such as winter, when skiing, snowboarding and snowmobiling are popular. Cloudy days are as hazardous as sunny ones; the only sure prevention is when outside, cover up.

Pierce-Stewart is trying new avenues for outreach. She’s currently meeting with recreation and camp directors who will welcome thousands of children and adults to their programs this summer.

The medical profession has taken notice. At the 2016 annual meeting of the Commission on Cancer, a program of the American College of Surgeons, Peter Hopewood, M.D., praised the program as a best practice, and said, “This program should be used throughout the U.S. by hospital and cancer programs to decrease the incidence and death rate from sunlight-related skin cancers, especially melanoma.”

Amylynne Frankel, M.D., concurs. An SMHC dermatologist, Frankel conducted the Skinny on Skin training.

“Most people only see a dermatologist once a year or less,” she said. “It can be difficult or impossible for someone to spot a suspicious lesion on their own head. By training hair care professionals what to look for, we are increasing the chances that skin cancer can be caught early when it can be treated, especially melanomas.”

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