So I had kind of a strange realization today when I was thinking about all the patients that I've ever had in the practice who had cancer. Especially the young ones.

When I think about it, they sort of have an unfortunate amount of other "minor" things going on that wouldn't really be remarked out of the scope of normal at a traditional examination, but is at the very least "unfortunate". Many of them are not what I would call "traditionally attractive" people in terms of facial structure, and many others have a large amount of actinic keratoses, seborrheic keratoses, and other skin lesions like you see almost on patients with bad diabetes but occurring at a much more severe rate than you would expect in someone of their age.

I know the logical answer here is that these people have some sort of micro deletions or other sort of chromosomal/genetic anomalies that predispose to these sort of things, but it's not really talked about in medicine in the scope of something less than more severe diseases like xeroderma pigmentosem or lynch or li fraumeni etc. I wondered if it was something that was a phenomenon noted by other family practice docs. Sort of a more subtle indicator of lifetime cancer risk.

I didn't want to post this in /r/medicine as I didn't think it would be received that well, but being as were clinicians that follow patients for literally decades, I thought this might be a trend that other FP docs may have noted.

What really set me off was a young guy I saw recently who came in for a chronic cough, and he had some weight loss, but he was pretty young. He had an extremely large amount of moles and other skin anomalies for someone his age, and my brain immediately went to (DNA damage / DNA repair / Cancer) even though based on his age and exposures, stuff like tuberculosis or chronic pneumonia or other things were way more likely. It unfortunately did turn out to be cancer, and so I've just been thinking about this and all of my past patients.

If this is something you've also noted, let me know that I'm not crazy please.