· Executive Brief
National Healthy Skin Month 2026
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership signal
National Healthy Skin Month can serve as an executive operating checkpoint.
Awareness can generate questions and requests for help. Executive teams can prepare by clarifying the first point of contact, the qualified team that accepts the request, the handoff standard, and the method used to verify completion without assuming that one route fits every person.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Skin health is an access route before it is a campaign
Skin concerns reach health systems through many doors: primary care visits, urgent care, pharmacies, workplace programs and long dermatology queues. Most of that demand is routine, but some of it involves cancer, where timing matters. In national U.S. registry data, melanoma incidence rose from 15.1 per 100,000 in 1999 to 23.0 per 100,000 in 2021.[15] Five-year relative survival was 99.4% for localized melanoma and 35.6% for distant melanoma.[15] That gap makes the speed of detection and evaluation an operating question for executives.
The route into specialty care is often where people fall out. In a secret shopper study of dermatology offices in Hawaii, 34% accepted Medicaid, compared with 95% for private insurance and 93% for Medicare.[13] In a California Medicaid plan, specialists recommended in-person follow-up when an eConsult was not enough, yet 57% of those dermatology patients did not receive in-person specialty care.[10] These are failures of routes, handoffs and capacity rather than of any single clinician.
Prevention has its own operating gaps. Outdoor workers carry a measurable occupational risk, and a simple workplace program that made sunscreen easy to get was associated with much higher reported use.[2][3] Primary care teams, community pharmacists and teledermatology services can extend detection capacity.[6][7] That extension works only when requests are well formed, clinicians are trained and referrals are completed.[5][7]
National Healthy Skin Month gives leaders a reason to examine these routes with evidence in hand. The sections below summarize peer-reviewed research on burden, prevention, access, transitions, equity, workforce and communication. Each section names the operating question the evidence raises. They sit beside the executive guidance already on this page and are meant to help boards and operating leaders decide where to act first.
Current evidence
What the research says about burden, risk and stage at diagnosis
Most melanoma is found early, but a meaningful share is not. In the same national registry analysis, 77% of cases were localized at diagnosis, 9.5% were regional, 4.7% were distant and 8.8% were unstaged.[15] The upward incidence trend was consistent across gender and racial and ethnic groups.[15] The authors emphasized the critical role of early detection in improving survival outcomes.[15] An unstaged share of that size is also a documentation signal that cancer programs can monitor alongside clinical results.
Occupational exposure adds a burden that sits partly outside the clinic. A Danish cohort followed 2.9 million workers for a median of 19 years, and 11,344 developed cutaneous melanoma.[2] Workers in the highest quartile of cumulative occupational solar exposure had an adjusted incidence rate ratio of 1.57 compared with the lowest quartile.[2] Risk rose with cumulative dose, reaching a peak incidence rate ratio of 1.59 at 14.80 standard erythema dose-years in the spline analysis.[2] The authors concluded that the findings highlight an urgent need for workplace sun-protection policies.[2] For health systems that serve construction, agriculture, utilities or public works, prevention is partly an employer partnership question.
Stage at diagnosis also differs between groups. In a Danish national cohort of 30,497 people with melanoma, men had higher adjusted odds than women of distant metastases at diagnosis (adjusted odds ratio 1.69).[12] Among people with localized melanoma, men also had a higher adjusted hazard of melanoma-specific mortality (adjusted hazard ratio 1.51).[12] Their adjusted hazard of recurrence was higher as well (adjusted hazard ratio 1.38).[12] Differences of this kind suggest that outreach and detection routes may need to reach some groups more deliberately.
U.S. data show variation by place and coverage. In a national analysis of 986,555 patients diagnosed with melanoma from 2004 to 2020, uninsured rates were highest in the Southwest (3.4%) and Southeast (2.4%).[1] The authors wrote that regional disparities likely reflect structural inequities in screening access, insurance coverage and health care infrastructure.[1] Those are factors that health systems, payers and public health partners can influence together. They also vary enough between regions that national averages may hide the local picture.
Taken together, the evidence describes a condition where early detection is strongly associated with survival, and where exposure, coverage and geography shape who is detected early. The most useful local information is therefore not the volume of awareness activity. It is whether people with concerning lesions or high exposure reach a timely, completed evaluation.
Figure 1
Where dermatology access and detection routes leak
Percent reported in each study for a step in the skin health access or detection route. Values are copied from the cited studies [5], [7], [10], [13]; none is estimated.
Data note. Except for the two Hawaii acceptance values, these figures come from different studies, countries, populations and definitions, so this is an indirect comparison that shows where routes leak rather than how one step compares with another.
Limitation. Each value reflects its own setting and denominator; the Saudi and French values are from outside the United States and may not transfer directly.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Dermatology offices accepting Medicaid | 34% | Secret shopper study of dermatology offices accepting new patients in Hawaii | [13] |
| Dermatology offices accepting private insurance | 95% | Same Hawaii secret shopper study, for comparison within one study | [13] |
| Dermatology patients recommended for in-person care who did not receive it | 57% | eConsults in a California Medicaid plan, January to June 2022 | [10] |
| Primary care physicians who had performed a full-body skin examination for screening | 24.5% | Nationwide survey of 159 primary care physicians in Saudi Arabia | [5] |
| Tele-expertise requests that avoided a face-to-face consultation | 51% | 3,266 requests in a French regional network, 2022 to 2024 | [7] |
Continuum of care
Where skin health handoffs break between primary care and dermatology
The handoff from primary care to dermatology is the most common point of failure. A study of 2,505 eConsults in a California Medicaid plan from January to June 2022 cross-referenced each request with claims and authorization records.[10] Only 27% of dermatology eConsults resulted in specialist advice, and 57% of dermatology patients recommended for in-person follow-up did not receive that care.[10] Gaps in in-person follow-up also appeared in pulmonology (71%) and urology (53%), so the problem is not unique to dermatology.[10] The authors called for standardized protocols and better triaging.[10]
Well-designed asynchronous routes can carry more of the load. A French regional tele-expertise network analyzed 3,266 cases received from 2022 to 2024 and cross-referenced them with patient records when an in-person consultation occurred.[7] The median specialist response time was 13 hours, and tele-expertise avoided face-to-face consultations in 51% of cases.[7] Diagnostic concordance was 92.4%.[7] Fast asynchronous routes, in other words, do not have to trade away accuracy.
Implementation design matters as much as the technology. At a statewide Federally Qualified Health Center, 69 primary care providers at 16 sites submitted 560 dermoscopy-enabled eConsults for 526 unique patients.[11] After training, providers submitted a higher proportion of dermatology referral requests as eConsults rather than face-to-face visits (28.6% versus 17.3%).[11] The authors concluded that broad adoption helped provide dermatology care to Medicaid-insured and uninsured patients who might otherwise have been unable to obtain it.[11]
Community entry points create additional handoffs. In a Spanish study, community pharmacists recruited 340 participants, 240 were assessed by primary care physicians, and 74 were referred to dermatologists for diagnostic confirmation.[6] Among referred patients, 15 malignant lesions were confirmed: one melanoma, one squamous cell carcinoma and 13 basal cell carcinomas.[6] Seven actinic keratoses were also confirmed.[6] Each step in that chain is a transition where a person can be lost, so each needs an owner and a visible status.
For executives, the pattern is consistent across settings. An eConsult or community referral is a beginning, not an outcome. The measure that matters is whether the recommended next step, whether advice, a biopsy or an in-person visit, actually happens and is documented. Where that outcome is not tracked, leaders cannot tell a working route from a stalled one.
Figure 3
Why the pathway breaks
People
- Primary care clinicians without skin cancer training
- Few specialists available to Medicaid patients
- Community entry points without a defined receiving clinician
Process
- eConsult recommendations for in-person care not scheduled
- Incomplete teledermatology requests returned for more information
- No owner for each step from community screening to dermatology
Technology
- No dermoscopy or imaging tools in primary care
- Time-consuming eConsult workflows and poor image quality
- Referral status not visible across organizations
Environment
- High occupational sun exposure among outdoor workers
- Island, rural or regional distance from dermatology offices
- Prevention resources not tailored by language or culture
Policy
- Low Medicaid acceptance by dermatology offices
- Uninsured patients concentrated in some regions
- Payment models with limited specialty participation
Measurement
- Completion of recommended visits not tracked
- Stage at diagnosis not stratified by coverage, sex or region
- Skin of color representation in training not reviewed
Unranked qualitative cause-and-effect diagram for the outcome in the box: People with a concerning skin lesion or high ultraviolet exposure do not reach a timely, completed dermatologic evaluation Causes are assembled from the cited literature [1], [2], [4], [5], [7], [8], [9], [10], [11], [12], [13]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Primary care clinicians without skin cancer training; Few specialists available to Medicaid patients; Community entry points without a defined receiving clinician |
| Process | eConsult recommendations for in-person care not scheduled; Incomplete teledermatology requests returned for more information; No owner for each step from community screening to dermatology |
| Technology | No dermoscopy or imaging tools in primary care; Time-consuming eConsult workflows and poor image quality; Referral status not visible across organizations |
| Environment | High occupational sun exposure among outdoor workers; Island, rural or regional distance from dermatology offices; Prevention resources not tailored by language or culture |
| Policy | Low Medicaid acceptance by dermatology offices; Uninsured patients concentrated in some regions; Payment models with limited specialty participation |
| Measurement | Completion of recommended visits not tracked; Stage at diagnosis not stratified by coverage, sex or region; Skin of color representation in training not reviewed |
Access
Insurance, geography and payment design shape who gets seen
Coverage remains a direct barrier to dermatology appointments. Of 46 dermatology offices contacted in Hawaii, 41 (89%) were accepting new patients.[13] Thirty (73%) were on O’ahu, and the remaining 11 (27%) were spread across the neighboring islands.[13] Medicaid acceptance was 34%, significantly lower than acceptance of private insurance and Medicare.[13] Acceptance for Medicaid was 27% on O’ahu and 55% on the neighboring islands, although that difference was not statistically significant.[13] Average wait times did not differ significantly by insurance type.[13] For Medicaid patients in that study, the first barrier was getting accepted at all.
Teledermatology can reach different patients than in-person clinics. A Texas health system compared 893 eConsult visits with 27,189 in-person dermatology encounters from January 2022 to March 2023.[14] Pediatric patients made up 22.5% of eConsults versus 7.6% of in-person visits.[14] eConsult users came from areas with lower average household income and a higher proportion of Medicaid and Tricare users.[14] The authors noted that this was a descriptive analysis in a single health system with limited generalizability.[14] Physicians submitted more eConsult cases than nonphysician providers, with comparable diagnostic agreement with teledermatologists.[14]
Request quality is part of access. In the French tele-expertise network, general practitioners submitted 99.2% of requests, and only 4% of requests were rejected for insufficient information.[7] Skin cancer screening was the most frequent indication, at 59.6% of requests.[7] When a request is incomplete, the patient waits for another cycle, so the quality standard for submissions is an access standard as well.
Payment design affects the economics of specialty participation. Using 2023 federal data on 291,121 clinicians across 29 specialties, a study found that participation in alternative payment models ranged from 7.6% in dermatology to 40.6% in hospital medicine.[9] Clinicians reporting through such models generally received higher predicted payment adjustments than comparable group-reporting clinicians.[9] The adjusted difference ranged from $100 for obstetrics and gynecology to $2327 for radiation oncology.[9] The authors suggested that specialists with lower access to these models may face a systematic financial disadvantage.[9]
These findings point to levers within executive reach. Leaders can review which plans their dermatology services accept, whether eConsult routes are available to every primary care site, and whether value-based arrangements include specialty-relevant measures.
Executive guidance · System route
Build one visible operating route for National Healthy Skin Month.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Link prevention and access
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Link prevention and access
Connect approved prevention communication to clear entry points, designated receiving services, transition ownership, and follow-through.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Link prevention and access | Connect approved prevention communication to clear entry points, designated receiving services, transition ownership, and follow-through. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity gaps in skin health appear in coverage, stage and representation
Insurance type shapes the first step. The Hawaii study found that Medicaid recipients might experience difficulty accessing dermatology care compared with people who have private insurance or Medicare.[13] The California eConsult analysis was set in a region where Medicaid patients often face prolonged waits for primary and specialty care.[10] When the route depends on coverage, equal awareness messages do not produce equal access.
Place and coverage are tied to stage at diagnosis. The national melanoma analysis recommended region-specific interventions, including Medicaid expansion, increased access to dermatologic care, public awareness campaigns and targeted screening.[1] The Danish sex-difference findings add a reminder that disparities are not limited to income or insurance.[12] The national analysis also reported that patients had a mean age of 65.3 years and that 60.1% were male.[1] Health systems can stratify their own stage and time-to-evaluation data to see which groups are reaching care later.
Clinician training affects how well skin conditions are recognized across skin tones. A survey of dermatology departments at 57 medical schools in Germany, Austria and Switzerland had a 65% response rate.[8] Among responding faculties, 65% (24/37) included skin of color education in mandatory teaching, and 62% cited lack of teaching materials as a barrier.[8] Most of those faculties (83%, 20/24) had introduced the content within the previous four years.[8] Insufficient expertise (24%) and limited curriculum time (22%) were also reported as barriers.[8] Only 14% (5/37) included skin of color questions in final examinations.[8] The study noted that dermatology educational resources predominantly depict lighter skin types.[8]
Prevention resources are not equally tailored. Hispanic individuals make up a large share of the U.S. outdoor workforce but have limited access to culturally tailored prevention resources.[4] In an exploratory study of Spanish-speaking Hispanic outdoor workers, 47.4% reported six to nine hours of outdoor work per day and 52.6% reported not engaging in sun protection.[4] Those figures come from 19 participants, so they describe a need rather than a population rate.[4]
Trust grows when underserved groups can see that routes work for them. The Texas eConsult findings suggest that remote routes can broaden access for children, Medicaid and Tricare members and people from underrepresented backgrounds.[14] Executives can test that promise locally by reporting completion and time to evaluation by coverage, language and geography. Publishing those results, including where the organization falls short, is itself a trust-building act.
Human infrastructure
The people who extend dermatology capacity
Dermatologists alone cannot meet demand for skin evaluation, so primary care clinicians carry much of the detection work. A nationwide survey of 159 primary care physicians in Saudi Arabia found that 90.6% met the threshold for adequate knowledge and 89.3% for positive attitudes.[5] Yet only 34.6% met the study’s definition of proper practice.[5] Only 24.5% had performed a full-body skin examination for screening, and 20.8% used diagnostic tools for suspicious lesions.[5] Only 23.3% routinely counseled patients on sun protection.[5]
The barriers were operational rather than motivational. The most frequently reported barriers were lack of access to diagnostic tools (74.2%) and absence of clear clinical protocols for screening or management (69.2%).[5] Training attendance and more years in practice were independently associated with proper practice, yet only 32.7% had attended skin cancer continuing education.[5] Tools, protocols and protected training time are workforce investments that executives control. Each one can be inventoried by site, which turns a general concern about detection into a concrete gap list.
Training also changes the quality of teledermatology requests. In the French network, training of general practitioners in dermatology and dermoscopy significantly improved request quality and produced more efficient specialist responses.[7] The authors concluded that tele-expertise is highly dependent on the requesting physician’s level of training.[7] Only 4% of requests were rejected for insufficient information.[7] That rate depends on request discipline as much as on specialist effort. A teledermatology contract without a training plan may therefore underperform its potential. Skin cancer screening was the leading reason for requests, so training directly affects the cancer detection route.[7]
New roles can widen the front door. In Barcelona province, 184 community pharmacists from 104 pharmacies worked with 49 primary care physicians and referral dermatologists in a coordinated screening route.[6] Those pharmacies represented 4.34% of all pharmacies in the province.[6] The authors concluded that pharmacists were able to identify skin cancer risk factors that enabled the diagnosis of a significant number of occult skin cancers.[6] That model depends on clear referral rules and receiving capacity at each downstream step.
Primary care adoption of eConsults also depends on support. The federally qualified health center program trained primary care providers before measuring the shift toward eConsults, and the authors noted that many programs struggle with image quality and time-consuming workflows.[11] Workforce planning for skin health should therefore include devices, workflow time and training, not only specialist headcount.
Executive guidance · Operating dashboard
Use a small dashboard to expose friction and ownership.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Prevention-to-access alignment
Do campaign messages lead to current, usable, and appropriately bounded access instructions?
- Candidate local measure
- Locally defined conflicting instructions, misroutes, repeat contacts, unaccepted handoffs, and communication corrections.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Prevention-to-access alignment | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Close the loop across teams, settings, and partners.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Confirm the designated receiving service and avoid language that promises a determination, timing, or outcome.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Give leaders one view of route reliability and improvement.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Prevention-to-access alignment | Do campaign messages lead to current, usable, and appropriately bounded access instructions? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a reliable skin health access route
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Insurance acceptance review for new dermatology patients | Medicaid patients cannot obtain a first appointment | Chief operating officer with dermatology service line lead | New-patient acceptance by plan, reviewed against community coverage mix |
| Closed-loop tracking of eConsult recommendations | Patients advised to have in-person care never receive it | Ambulatory access director and referral management lead | Share of in-person recommendations completed, with documented outreach for the rest |
| Teledermatology request standard and training | Incomplete requests delay specialist input | Primary care medical director with teledermatology lead | Rejection rate for insufficient information and training completion by site |
| Primary care tools and protocols for skin lesion evaluation | Suspicious lesions are not examined or imaged consistently | Chief medical officer and primary care leadership | Sites with dermoscopy access and an approved protocol |
| Stage and time-to-evaluation review by group | Later-stage diagnoses concentrate in some groups unseen | Cancer committee and board quality committee | Stage at diagnosis and time to evaluation stratified by coverage, sex, region and language |
| Employer and community prevention partnerships | Outdoor workers lack easy access to sun protection and evaluation routes | Community health or population health lead | Active partnerships with documented access and referral paths |
| Skin tone representation in training and patient materials | Conditions are recognized less reliably across skin tones | Chief learning officer and patient education lead | Audit of images and curricula for representation |
Control points derived from the cited evidence [3], [5], [7], [8], [10], [12], [13] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Messages that reach outdoor workers and lead to a real next step
Communication works best when it is paired with practical access. A German workplace study enrolled 234 outdoor workers during the April to September 2025 sun season.[3] The intervention combined facilitated access to sunscreen products with brief structured education on ultraviolet risk and correct sunscreen use.[3] Each group had 117 participants, and 97 in the intervention group and 86 in the control group completed the study.[3] At baseline, 54.7% of participants reported using sunscreen at least sometimes.[3] At six months, that proportion was 83.5% in the intervention group and 52.3% in the control group.[3]
The same study shows why claims should stay modest. Reported sunburns fell in both groups, and the difference between groups over time was not statistically significant.[3] The design was non-randomized, so the result is an association rather than proof of effect. Health system partners who sponsor workplace programs can describe the program as low-threshold and feasible, which is how the authors framed it.[3] The intervention group also showed a stronger reduction in reported sunburns, although that difference did not reach statistical significance.[3]
Culturally tailored content can earn attention and credibility. Spanish-speaking Hispanic outdoor workers described a narrative prevention video as culturally resonant, realistic and engaging.[4] Identification with characters and family-centered themes increased perceived relevance and message credibility.[4] Many participants reported increased awareness of skin cancer risk and greater confidence in adopting sun-protective behaviors.[4] Participants recommended sharing the video through workplaces, social media, schools, daycares, clinics and other community settings.[4] The authors noted that randomized studies are still needed to assess long-term effects.[4]
Public messages also need to match the real route. In the Hawaii study, most offices were accepting new patients, yet only about a third accepted Medicaid.[13] Primary care eConsult routes, by contrast, reached Medicaid-insured, uninsured and pediatric patients in the studies reviewed here.[11][14] Messages that name such a concrete path are more useful than a general instruction to see a dermatologist.
Early detection is the strongest shared message across the evidence, because survival differs sharply by stage at diagnosis.[15] The Danish worker cohort found that melanoma risk rose with cumulative occupational exposure, which makes workplaces a natural channel.[2] Trust grows when people who act on a message find an entry point that accepts them, a handoff that holds and a result that is communicated back to them.
Executive guidance · 90-day plan
Turn the observance into one sustained operating change.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how National Healthy Skin Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Compare one prevention message with the real access route and correct a verified mismatch.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how National Healthy Skin Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Compare one prevention message with the real access route and correct a verified mismatch. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Make National Healthy Skin Month a starting point, not an endpoint.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Make ownership visible, test the route, and report what improved.
Executive action kit · Month observance
Turn National Healthy Skin Month into accountable action.
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership focus
Use this observance to examine trustworthy information, prevention access, and community connection. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, prevention access, evaluation navigation, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review representation across skin tones, language, digital access, transportation, cost, disability, and geographic access.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, primary care, specialty services, community partners, and communications teams. Find one unclear information, delayed connection, or a referral without ownership, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Link prevention and access
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined conflicting instructions, misroutes, repeat contacts, unaccepted handoffs, and communication corrections.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Public Health and Community Partners
Staff communication template
During National Healthy Skin Month, our organization will connect awareness with a practical review of the information, prevention access, evaluation navigation, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
National Healthy Skin Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Brock LF, Demirors B, Godbole N, Bowers JC, Manaise HK, Mahesh VA, et al. Regional Disparities in Socioeconomic Factors and Advanced-stage Presentation in Melanoma: A National Cancer Database Analysis (2004-2020). Anticancer Research. 2026;46(9):4985-4991. https://doi.org/10.21873/anticanres.18348
- 2.Kristensen I, Schmidt SAJ, Gorny AW, Iversen IB, Fenger-Grøn M, Würtz ET, et al. Occupational solar UV-exposure and risk of cutaneous melanoma among Danish workers: A nationwide cohort study. European Journal of Cancer. 2026;244:116884. https://doi.org/10.1016/j.ejca.2026.116884
- 3.Dick A, Ludewig M, Skudlik C, Jakasa I, Kezic S, de Boer F, et al. Increasing topical sunscreen use in German outdoor workers: results of a non-randomised controlled intervention study. BMC Public Health. 2026;26(1):2656. https://doi.org/10.1186/s12889-026-29422-6
- 4.Perez D, Gómez V, Sedeño-Delgado D, Orellana García C, Chacon M, Gonzalez M, et al. Perceptions of a Culturally Tailored Narrative Video for Skin Cancer Prevention Among Spanish-Speaking Hispanic Outdoor Workers: Exploratory Study. JMIR Dermatology. 2026;9:e98130. https://doi.org/10.2196/98130
- 5.Alqerafi A, Alshehri NA, Alghamdi KM. Underperformance in Skin Cancer Practices Despite Good Knowledge and Attitudes Among Primary Care Physicians. Clinical, Cosmetic and Investigational Dermatology. 2026;19:1-12. https://doi.org/10.2147/ccid.s623206
- 6.Pappalardo M, Alcalde M, Estrada M, Mir JF, Casas J, Rodriguez C, et al. Assessing the role of community pharmacists in early skin cancer detection: a real-world study. Scientific Reports. 2026;16(1):23426. https://doi.org/10.1038/s41598-026-54469-1
- 7.Corrente C, Baudry A, Pedailles S. Improving dermatology tele-expertise through physician training: evidence from a large real-world cohort. European Journal of Dermatology. 2026;36(4):339-344. https://doi.org/10.1684/ejd.2026.5111
- 8.Matthes N, Kött J, Heinen I, Booken N, Schneider SW, Abeck F. Current skin of color representation in medical school dermatology education in Germany, Austria and Switzerland (DACH region). JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2026:ddg.70529. https://doi.org/10.1111/ddg.70529
- 9.Letchuman S, Letchuman R, Poeran J, Gal J. Payment adjustments by physician specialty and participation type in the Merit-Based Incentive Payment System. Baylor University Medical Center Proceedings. 2026;39(6):1109-1112. https://doi.org/10.1080/08998280.2026.2724233
- 10.Thind BS, Maddalena M, Baqai W, Frencher SK, Jih WW. Evaluating the Impact of an eConsult Platform on Specialty Care Access for Medicaid Patients. The Journal of the American Board of Family Medicine. 2025;38(3):592-598. https://doi.org/10.3122/jabfm.2024.240322r1
- 11.Bifulco L, Anderson DR, Kvorning Ternov N, Seiverling EV. Implementation and Impact of a Dermoscopy-Enabled Dermatology eConsult Application in Primary Care. Journal of Primary Care & Community Health. 2025;16:21501319251403076. https://doi.org/10.1177/21501319251403076
- 12.Lyngstrand JE, Røssell EL, Bønnelykke-Behrndtz ML, Laurberg T. Sex disparities in melanoma stage, recurrence and mortality: A Danish cohort study, 2004 to 2024. Journal of the European Academy of Dermatology and Venereology. 2025;40(9):1515-1524. https://doi.org/10.1111/jdv.70180
- 13.Tran A, Leibovitch E, Stafford M, Prabhudesai D, Chen JJ, Witten N. Access to Dermatological Appointments Based on Insurance Types in Hawaiʻi. Cureus. 2024. https://doi.org/10.7759/cureus.66650
- 14.Bui IT, Youssef RM, Gracey LE. An Investigation of Teledermatology Trends in the State of Texas: A Multicenter, Retrospective Cohort Review of an eConsult Service Line. Telemedicine and e-Health. 2024;30(6). https://doi.org/10.1089/tmj.2023.0629
- 15.Okobi OE, Abreo E, Sams NP, Chukwuebuni OH, Tweneboa Amoako LA, Wiredu B, et al. Trends in Melanoma Incidence, Prevalence, Stage at Diagnosis, and Survival: An Analysis of the United States Cancer Statistics (USCS) Database. Cureus. 2024. https://doi.org/10.7759/cureus.70697
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Melanoma incidence trends, stage distribution and stage-specific survival | [15] | 2024 | Current evidence | Descriptive national registry trends from 1999 to 2021; survival is relative survival by stage, not an evaluation of any screening program. |
| Occupational solar UV exposure and melanoma risk | [2] | 2026 | Current evidence | Danish cohort with exposure estimated from a job exposure matrix; association, not causation. |
| Sex differences in melanoma stage and stage-specific mortality | [12] | 2025 | Current evidence | Danish population; findings may not transfer directly to U.S. health systems. |
| Regional socioeconomic variation among U.S. melanoma patients | [1] | 2026 | Current evidence | Cross-sectional facility-based cancer registry analysis; structural explanations are the authors’ interpretation. |
| eConsult completion and in-person follow-up for Medicaid patients | [10] | 2025 | Continuum of care | One Medicaid plan in one California region over six months; three specialties combined in design. |
| Tele-expertise response time, avoided visits, concordance and training | [7] | 2026 | Continuum of care | Retrospective single-center regional network in France. |
| Dermoscopy-enabled eConsult implementation in a federally qualified health center | [11] | 2025 | Continuum of care | Quality improvement pre-post comparison in one statewide organization. |
| Community pharmacist role in skin cancer risk identification and referral | [6] | 2026 | Human infrastructure | Volunteer participants in one Spanish province; attrition between steps not explained in the abstract. |
| Dermatology appointment access by insurance type | [13] | 2024 | Access | Secret shopper study of 46 offices in Hawaii; small Medicaid sample. |
| Teledermatology eConsult users compared with in-person patients | [14] | 2024 | Access | Descriptive analysis in a single Texas health system with limited generalizability. |
| Alternative payment model participation and payment adjustments by specialty | [9] | 2026 | Access | Federal 2023 data on Medicare physician payment; dermatology-specific effects on access are not measured. |
| Skin of color representation in dermatology education | [8] | 2026 | Equity and trust | Questionnaire of medical school departments in three European countries; 65% response rate. |
| Primary care physician skin cancer knowledge, practice and barriers | [5] | 2026 | Human infrastructure | Self-reported cross-sectional survey of 159 physicians in Saudi Arabia. |
| Workplace sunscreen access and education for outdoor workers | [3] | 2026 | Public communication | Non-randomized design over one season; self-reported sunscreen use. |
| Culturally tailored prevention video for Hispanic outdoor workers | [4] | 2026 | Public communication | Exploratory qualitative study with 19 participants. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
View Greg’s profile©2014 – 2026 The Healthcare Executive. All rights reserved.