Audiologists May Be an Untapped Line of Defense Against Skin Cancer

The ear is one of the most sun-exposed and most overlooked surfaces of the human body. It juts outward from the head, catching ultraviolet radiation from above and from the side, and its thin skin, cartilaginous ridges, and shadowed crevices make it a place where basal cell carcinomas, squamous cell carcinomas, and melanomas can quietly grow while patients and clinicians alike look the other way. Dermatologists see the consequences of that neglect, but a new study suggests that the people who spend their entire careers looking closely at ears may be able to catch these cancers far earlier than anyone expected. The catch is that audiologists, until now, have almost never been asked to think about skin cancer at all.

That blind spot is what motivated a team at the South Texas Veterans Health Care System (STVHCS) and the University of Texas Health Science Center at San Antonio. In a short report published in the Archives of Dermatological Research, Ruoxuan Su, Brooke A. Burgess, and Joshua L. Owen describe a brief educational intervention designed to turn audiologists into informed observers of the skin they examine every day. The idea borrows deliberately from an established precedent: hairdressers, who see the scalp and neck in detail that physicians rarely do, have been studied for more than a decade as potential facilitators of skin cancer screening. Prior research in Houston salons and rural salons across the United States showed that with targeted education, non-physician professionals could recognize suspicious lesions and encourage clients to seek dermatologic evaluation. Nobody, however, had ever asked whether the same logic applies to the clinicians with arguably the best view of the ear in all of medicine.

The rationale is anatomically straightforward. Audiologists perform otoscopy, fit hearing aids and earmolds, and manipulate the pinna and external auditory canal dozens of times a day. They routinely illuminate the ear canal and the concha with an otoscope light, and they see patients who may not have had a full-body skin examination in years. Veterans, the population served by STVHCS, carry a particularly heavy burden of cumulative sun exposure from outdoor military service and outdoor occupations, making the head and neck an especially high-yield region to monitor. If an audiologist could recognize that a crusted, pearly, or irregularly pigmented lesion on the helix deserves a dermatology referral, the diagnostic pathway for that patient could begin years earlier than it otherwise might.

To test whether such recognition could be taught quickly, the researchers surveyed audiologists at STVHCS before and after an educational session on skin cancer. The numbers were small, as is typical for a proof-of-concept study at a single institution: twelve participants completed the pre-intervention survey and eight completed the post-intervention survey. But the baseline findings were striking. Every single participant reported having received little or no prior skin cancer training, despite spending their professional lives in close visual contact with one of the highest-risk skin sites on the body. At the same time, 58 percent of respondents, seven of the twelve, expressed strong interest in receiving exactly that kind of education. The appetite was there; the training simply had never been offered.

The educational intervention itself was deliberately brief, reflecting the reality that audiologists cannot be expected to complete dermatology coursework on top of their clinical duties. After the session, participants retook a knowledge assessment, and the results were statistically convincing. Overall knowledge scores rose significantly, with a p-value of 0.0023, a threshold that indicates the improvement was very unlikely to be a chance artifact of the small sample. When the researchers broke the results down by lesion type, they found significant gains in the ability to distinguish benign lesions, at p equal to 0.039, and malignant lesions, at p equal to 0.046. Knowledge of premalignant lesions, such as actinic keratoses, did not improve significantly, with a p-value of 0.5, a gap the authors’ data suggest may reflect the inherent subtlety of these lesions or the limited time available to cover them.

Perhaps the most reassuring number in the study concerns referral accuracy. Even before the intervention, the audiologists were already highly reliable at flagging the lesions that matter most: after education, referral accuracy stood at 100 percent for basal cell carcinoma and squamous cell carcinoma, and 94 percent for melanoma. In practical terms, this means that when shown images of the two most common skin cancers and the deadliest one, the trained audiologists essentially never failed to identify them as lesions warranting dermatologic evaluation. For a screening facilitator role, that is precisely the performance profile you want. The goal is not to turn audiologists into diagnosticians; it is to ensure they know which findings should never be ignored, and the data indicate a short session achieves that.

The qualitative feedback from participants reinforced the quantitative results. Audiologists reported a heightened awareness of their potential role in skin cancer detection, greater familiarity with melanoma and its warning signs, and increased comfort with the process of referring patients to dermatology. That last point matters more than it might appear. Referral comfort is often the bottleneck in interprofessional screening schemes: a professional may notice something suspicious but hesitate to act, uncertain whether raising the concern is appropriate or how to route the patient. By explicitly framing dermatology referral as part of the audiologist’s scope, the intervention appears to have lowered that psychological barrier.

The study’s limitations are worth stating plainly. With twelve pre-intervention and eight post-intervention participants at a single veterans’ health care system, the findings are exploratory rather than definitive, and the authors themselves frame the work as identifying gaps and proposing a solution rather than establishing a new standard of care. The survey was anonymous and voluntary, the study was reviewed by the University of Texas Health Science Center at San Antonio institutional review board and determined not to be regulated human research, and no protected health information was collected. Whether the knowledge gains persist over months, whether they translate into real referral behavior in the clinic, and whether they improve patient outcomes such as time-to-diagnosis will require larger, longitudinal studies across multiple centers. The authors report no funding source and no conflicts of interest, and the work was conducted in accordance with the Declaration of Helsinki.

Even so, the implications are hard to dismiss. Skin cancer remains the most common malignancy in the United States, and early detection is the single most powerful lever for reducing morbidity, mortality, and treatment costs. The ear, along with the rest of the head and neck, is a site where lesions are both common and easy to miss, partly because patients cannot see their own ears well and partly because routine medical exams rarely involve a careful inspection of the pinna. Audiologists occupy a unique position at that intersection: they are medically trained, they look at ears under magnification and illumination every working day, and they see a patient population with elevated cumulative UV exposure. The STVHCS study suggests that a modest investment in education, the kind that could be delivered during a staff meeting or an online module, is enough to convert that positional advantage into genuine screening capacity.

The broader lesson may extend beyond audiology. The hairdresser studies that inspired this work demonstrated that non-dermatology professionals can serve as early-warning sensors when given the right tools, and the audiologist data now extend that principle to a clinical discipline with direct, repeated access to a high-risk anatomical site. As health systems search for scalable ways to catch skin cancers earlier, the cheapest interventions are often the ones that repurpose expertise that already exists inside the building. Twelve audiologists in San Antonio may seem like a small starting point, but the finding that a brief educational session can significantly raise skin cancer knowledge and sustain near-perfect referral accuracy for malignant lesions points to a simple, testable idea with obvious room to grow: the ears are already being examined, and now the people examining them know what to look for.

Subject of Research: Skin cancer knowledge and screening behaviors among audiologists following an educational intervention

Article Title: Skin cancer knowledge and screening behaviors amongst audiologists at South Texas Veterans Health Care System: identifying gaps and proposing a solution

Article References: Su, R., Burgess, B. A., & Owen, J. L. (2026). Skin cancer knowledge and screening behaviors amongst audiologists at South Texas Veterans Health Care System: identifying gaps and proposing a solution. Archives of Dermatological Research, 318(1), Article 426. https://doi.org/10.1007/s00403-026-04913-z

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04913-z

Keywords: skin cancer, audiologists, screening, educational intervention, dermatology referral, melanoma, basal cell carcinoma, squamous cell carcinoma, veterans health, early detection, otolaryngology, public health