Celebrating 30 years of skin cancer screening

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By Thomas Adams III, Publisher of Federal Public Medicine

As one of the most advanced and respected cancer research and treatment centers in our nation, Moffitt Cancer Center is leading the way in advancing understandings of various types of cancers and making a difference in early interventions by going out into communities throughout Florida to provide free screenings for people who might not have otherwise made the effort  to receive one on their own.

Moffitt’s “Mole Patrol®” is a shining example of dedication for helping people in need, and as it prepares to celebrate its 30th anniversary it was my great privilege to speak with Dr. Sondak and many of team members about the values this program has gained towards both early interventions and research understandings. And with the state of Florida being known as the sunshine state, skin cancer risks are extremely high, which is why this program has been so important to the community, and so successful with helping reach those at risk at the earliest stages possible that makes an enormous difference in their outcomes.

“Moffitt has been doing free skin cancer screenings at public locations around the state of Florida through its Mole Patrol pro- gram for nearly 30 years”, said Dr. Sondak, “and we do about 16 to 18 of these free screenings per year at all sorts of public venues. Last Saturday [November 22, 2025] was at a road race, and we also do them at air shows, baseball games, football games, and at Clearwater Beach, which is one of our main events, all to raise awareness about skin cancer, and the importance of sun protection along with promoting early detection of skin cancers when they can be treated much more effectively and often more simply than if they’re found later on.”

I was able to personally visit one of these events at a downtown festival held recently in Inverness, and noticed how positive the atmosphere was and convenient to get a free screening. I was also impressed at how the “Mole Patrol” uses creative connections for reaching people that were already there to enjoy the festivities, who may not have otherwise taken screening serious enough to go their own provider, or for those without a primary care provider or even insurance, but found this an excellent opportunity to take advantage of. This outreach into the community was very much in line with public health campaigns that partner with larger institutions and raise awareness within the community for all types of health initiatives, so I asked Dr. Sondak more about Moffitt’s connection with public health.

“Because Moffitt is a certified NCI Comprehensive Cancer Center, it is our obligation to address the public health needs very specifically of the population that we serve,” he stated, “and obviously, Florida is an area with a very high prevalence of skin cancer. We are actually the number two state in the nation for the number of cases of melanoma, second only to California. With almost as many cases, even though Florida has only about half the population of California, we clearly have a high rate of skin cancers. We have a lot of patients who are affected by it and so the Mole Patrol is part of the institutional public health outreach. We don’t necessarily interface directly with the public health organizations in the county or region, but the Moffitt outreach program component of the cancer center really looks at where all the underserved areas are and their needs. The Mole Patrol event in Inverness came about from our cancer center’s outreach team identifying this collaboration and finding the opportunity for not just us, but other parts of the cancer center to do free cancer screening. We recognize that skin cancer is a big factor in Florida, as it is in many other parts of the United States, and as a cancer center we take that very seriously as our obligation to seek out opportunities to partner with people and and get that message out.”

This is something else I noticed about the Mole Patrol screening events, that they often have other types of cancer screenings available including head and neck, as well as lung cancer screenings. This was a great example of the creativity organizers use when arranging their events, because the chances of people taking part in multiple screening while they are there already is very high, which provides an even greater ability for early detection among the most common types of cancers.

“The head and neck and lung cancer screenings are coordinated through Moffitt’s cancer center office for outreach”, Dr. Sondak stated, “Our team coordinates the skin cancer screenings and they coordinate the other screening programs, and alert us as to where there’s an opportunity. Out of anywhere from 16 to 18 Mole Patrol events held, nearly half a dozen of them involve at least one other type of cancer screaming team. Head and neck screening is very common because, like skin cancer, it is also a big problem that early intervention is critical for, and it’s something that you can easily screen for at the same time we screen for skin cancers. For lung cancer screenings, we need the bus with its equipment and resources for CT screening in a mobile unit, similar to breast cancer screenings and some of the other kinds of cancers that are not so easy to perform out in public,” he stated, “but we have an ability to raise awareness about all different kinds of screening, so about one third of our screenings each year involved at least one other Moffitt team screening for other forms of cancer.”

This led me to ask Dr. Sondak how Mole Patrol has provided additional information about not only skin cancer early detection, but also how to reach people at risk and what they have learned regarding this over the past 30 years.

“Our primary goal is education and early detection, so anything we can do to raise awareness that we think is going to be helpful. We have also tried to learn from studying our experiences at the Mole Patrol”, he said. “We have published some reports because a venue like this provides access to real world populations that might even be from other countries visiting Florida, who might have no insurance or healthcare on a regular basis, and we often get to approach people who are out in the sun a lot for their jobs to learn more. When we’re at the beach, we can screen lifeguards and police officers patrolling the beach, and we always impressed at how much sun exposure they’re getting and how we can try to help them prevent the damaging effects of the sun, so it is a research opportunity. We have done some studies and publications over the years about our efforts. It’s not the primary goal of course, but it’s just one of the many sort of collateral benefits of the effort.”

It certainly makes good sense to learn from these screenings as much as it does to perform them, and over the past 30 years Moffitt has taken great advantage of this opportunity. I asked Dr. Sondak to expand upon this regarding the gains he has personally seen as a result.

“The first thing we always like to emphasize is that we’ve seen dramatic progress in the treatment of melanoma and other skin cancers in the last decade,” he said, “even very advanced cases can now be treated and often with an expectation of survival that is encouraging us to say that they are being cured. Even very advanced widespread cases. And the life expectancy for the average patient with advanced melanoma has increased dramatically, but none of this changes the fact that if you can catch this disease early, when it’s right there on the skin for everybody to see, if you can spot it early, you don’t need all those expensive complicated and sometimes toxic treatments. You can take care of this with some local anesthesia in the doctor’s office with an extremely high chance of cure. So we want the message to be a positive one, that we’re making progress, but still this is a cancer that in almost every case is just right there, on the skin for some- body to see if only they know what to look for.”

Another opportunity Mole Patrol offers is understanding the knowledge individuals in their communities have about risk factors, and ways to prevent disease.

“Our experiences allow us to learn what kind of message gets through,” he Dr. Sondak stated, “because the best way to minimize the problems that we have with skin cancer is to avoid it entirely and prevent it from occurring by being careful about sun exposure. And most of the ultraviolet exposure we get in our lifetime is when we’re young, so targeting the message toward young people who are often hard to reach with a cancer prevention message is very important. We’ve learned from lung cancer and other kinds of conditions that it’s not always easy to get through to teenagers and young adults about the risks of their current behavior, when those risks are years in the future. So there’s a lot of research on what’s the best way to get that mes- sage across, and that’s something we continue to work on.”

The two biggest challenges for providing reliable screenings to those at risk is having people volunteer, and having trained professionals available to perform the examinations. Mole Patrol offers extremely qualified personnel to meet both of these, especially for underserved communities which may otherwise not have access to such important services.

I asked Dr. Sondak about their ability to have qualified professionals properly identify areas of concern, and what else could be done in the event a primary care or nursing professional may be the frontline caregiver to help a patient with suspicious lesions.

“The first message we have — and we emphasize to all of our new people who want to join the Mole Patrol and attend our training class about what to look for — is, it’s not your job to tell exactly what the spot is or make an exact diagnosis”, he said. “Your job as a screener is to ‘spot the spot,’ that is find the problem area or identify the ‘ugly duckling’ if you will, the mole that stands out and doesn’t look like it belongs there. Just identify the problem area and then get that person to somebody else who can evaluate it with more technological sophistication or more clinical sophistication, or just do a biopsy because it doesn’t really take much technology to say that doesn’t belong, let’s just cut it out and send it to the pathologist who can figure out which things are really bad. It’s actually one of the criticisms of widespread skin cancer screening, that sometimes you biopsy something and it isn’t cancer. That can be perceived as a negative about screening, but we don’t really think about that as a very big negative. Of course we’d like to be perfect and only removed things that are cancerous and never remove something that’s benign”, he stated, “but you cannot tell, not even the most experienced expert dermatologist can always tell if something is cancerous or not, you have to biopsy things to find out. Now of course at a place like Moffitt, we’re very interested in non-invasive technologies. Whether it’s looking with different kinds of magnification like confocal microscopy that lets us look under the layers of the skin, or genetic testing, or other different ways we are exploring”, he said, “still right now today the best, simplest, safest, and lowest cost approach is that if you see something suspicious and you’re not sure what it is, just do a biopsy or send the patient to someone who can.”

While biopsy is generally safe for most individuals, there are certain circumstances that could make them risky including bleed- ing disorders like hemophilia or anticoagulant use including blood thinners, as well as active infections or allergies to local anesthetics. This is where new advanced technologies such as like confocal microscopy can be extremely helpful, without introducing complications.

Skin cancer education materials have also been updated in recent times to help reflect more diverse skin tones, which can obviously make visual examinations more difficult to identify possible cancer. This is another example of how technology can be an essential tool in providing the healthcare professional with greater abilities to see more detail than even the most trained expert can see with the naked eye.

“The first thing we talk about when it comes to skin color differences in patient populations or groups of people is that there’s a huge knowledge void”, Dr. Sondak stated, “and you can’t screen somebody or diagnose their cancer unless they noticed some- thing first and come in because they are worried about it. We see over and over again that darker skinned people have a tendency not to be as concerned, thinking this isn’t a problem for me as much as it is for really fair skinned people. Or ‘I can’t get skin cancer’.”, he stated, “Whether it’s Hispanic, African-American, or just a darkly pigmented Southern European heritage, getting the message across that everybody can get skin cancer, no one is immune. The patterns may be a little different, but there are still major deficits in that knowledge, because it doesn’t matter what technology we have, if somebody doesn’t come in and say ‘hey, what do you think of this spot on my foot?’ we can’t do any- thing about it. That is a really big challenge, but if we can just get people in the door, then we can evaluate them. And many times we can reassure people, we can say this isn’t something that you have to worry about now, this is something you can keep an eye on and this is what you should be looking for, if you see this kind of a change. We don’t want to overlook the fact that even though our goal is to find cancers, a big byproduct of not finding cancer in a given person is reassuring them,” he stated, “as long as we are giving accurate reassurance that’s a big plus, and we are also educating them about what to expect in the future.”

This is exactly what Mole Parol does as it reaches out to the communities that have the same situations Dr. Sondak explained, reaching out to people that otherwise may not have any concern or even recognize a difference in their skin that could possibly be cancer.

“And we have to acknowledge that sometimes the medical profession hasn’t always been as aware of the different kinds of problems, including the kinds of cancers people get when their skin tones are diverse and not just your average white skinned individual,” he stated, “so we have work to do on the medical side as well as the population side to get the message out.”

Getting this important message out to those who need it can be extremely challenging. As with other types of screenings, such as sexually transmitted infections, one of the biggest barriers can be getting people to come in because of embarrassment or even lack of trust among the system.

This has been the case with both men and women regarding syphilis screening, even though it is especially crucial for pregnant women to get tested as early on in their pregnancy as possible to avoid congenital syphilis complications and death to their unborn child. This is why most states are now mandating screen- ing for this case, but trying to find ways of reaching these people and overcoming the barriers remains very challenging. One creative idea is introducing STI screening as a secondary test to other screenings such as breast and cervical cancer screenings. This allows the patient to avoid embarrassment.

Moffitt’s community screenings often include several screenings now such as head and neck, as well as lung cancer screenings. This makes it much easier to attract people at risk to get screened for multiple types of cancer, while they are already there and getting screened for one thing they can also receive another. This convenience factor has definitely boosted participation and made a huge difference it helping people catch cancers early where it can make all the difference.

Moffitt has truly made huge differences in so many people’s lives over the past 30 years, and it all comes down to the devotion of the professionals serving within their system. I asked Dr. Sondak about his background and what led him to serve in the area he is today.

“I wanted to be a cancer surgeon,” he said, “ever since my first year in medical school when I met the chief of cancer surgery at my medical school, Dr. Peter Mozden at Boston University School Medicine, and was just inspired by him. It was his mannerisms and approach to treating patients, even patients that we couldn’t help back in that day, in the 1970s. When I was in medical school, a lot of patients with melanoma and other skin cancers really didn’t have a lot of options for treatment. The challenge was, how do we manage them, how do we take care of them? How do we ease their symptoms and prevent the problems we could prevent? It was a big, big challenge in those days and I was really impressed with how he was able to handle them. That motivated me to go on to the career that I’ve had. And I was certainly attracted to melanoma and other skin cancer because of some of the same things we’ve been talking about, how they are on the skin for everybody to see, but if we miss catching them early, they can spread so widely and be so difficult to treat. And yet there was progress to be made, and the pace of the progress is far beyond anything I ever expected to to see in my career, so I’ve been really gratified with everything we’ve been able to accomplish for our patients over the years.”