Total Body Skin Examination Practices: A Survey Study Amongst Dermatologists at High-Risk Skin Cancer Clinics

Shirin Bajaj; Zachary J. Wolner; Stephen W. Dusza; Ralph P. Braun; Ashfaq A. Marghoob; Jennifer DeFazio

doi:10.5826/dpc.0902a09

Total Body Skin Examination Practices: A Survey Study Amongst Dermatologists at High-Risk Skin Cancer Clinics

Authors

Shirin Bajaj Dermatology Service, Memorial Sloan Kettering Cancer Center & Dermatology Service, New York University, NY, USA
Zachary J. Wolner Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Stephen W. Dusza Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Ralph P. Braun Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
Ashfaq A. Marghoob Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Jennifer DeFazio Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Keywords:

total body skin examination, skin cancer screening, melanoma, nonmelanoma skin cancer, cutaneous oncology

Abstract

Background/Objectives: Although total body skin examination (TBSE) is the primary screening mechanism for melanoma, there is no consensus on which anatomic sites a screening TBSE should include. We sought to establish which anatomic sites are examined during routine (>90%) TBSEs of patients at high risk for skin cancer.

Methods: A Google survey was emailed to 173 international dermatologist skin cancer specialists.

Results: More than 75% of participants reported routinely examining the scalp, ears, face and neck, trunk, breasts, inframammary areas, axillae, extremities, palms and soles, nails, interdigital spaces, and buttocks. The least frequently inspected anatomic sites included genitalia, with male genitalia more frequently examined than female (penis n = 39; 52%; labia majora n = 21; 28%; P = 0.003), the perianal region (n = 26; 34.7%), and the ocular conjunctiva and oral mucosa (n = 35; 46.7%). Participants cited not screening these areas because of perceived patient discomfort, low prevalence of malignancy, and the expectation that other specialists examine the area.

Conclusions: The role of routine surveillance of neglected anatomic sites is unclear and warrants further discussion weighing potential mortality benefit against the incidence of melanoma in obscure sites, morbidity of intervention in sensitive sites, cost-effectiveness, and potential for patient discomfort.

References

Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol. 2015;151(10):1081-1086.

Goldberg MS, Doucette JT, Lim HW, Spencer J, Carucci JA, Rigel DS. Risk factors for presumptive melanoma in skin cancer screening: American Academy of Dermatology National Melanoma/Skin Cancer Screening Program experience 2001-2005. J Am Acad Dermatol. 2007;57(1):60-66.

Aitken JF, Janda M, Elwood M, Youl PH, Ring IT, Lowe JB. Clinical outcomes from skin screening clinics within a community-based melanoma screening program. J Am Acad Dermatol. 2006;54(1):105-114.

Lookingbill DP. Yield from a complete skin examination: findings in 1157 new dermatology patients. J Am Acad Dermatol. 1988;18(1 Pt 1):31-37.

Weinstock MA, Martin RA, Risica PM, et al. Thorough skin examination for the early detection of melanoma. Am J Prev Med. 1999;17(3):169-175.

Weinstock MA, Ferris LK, Saul MI, et al. Downstream consequences of melanoma screening in a community practice setting: first results. Cancer. 2016;122(20):3152-3156.

Esteva A, Kuprel B, Novoa RA, et al. Dermatologist-level classification of skin cancer with deep neural networks. Nature. 2017;542(7639):115-118.

Marchetti MA, Chung E, Halpern AC. Screening for acral lentiginous melanoma in dark-skinned individuals. JAMA Dermatol. 2015;151(10):1055-1056.

Tsai MS, Chiu MW. Patient-reported frequency of acral surface inspection during skin examination in white and ethnic minority patients. J Am Acad Dermatol. 2014;71(2):249-255.

Mason AR, Mohr MR, Koch LH, Hood AF. Nevi of special sites. Clin Lab Med. 2011;31(2):229-242.

Haugh AM, Merkel EA, Zhang B, et al. A clinical, histologic, and follow-up study of genital melanosis in men and women. J Am Acad Dermatol. 2017;76(5):836-840.

Bishop KD, Olszewski AJ. Epidemiology and survival outcomes of ocular and mucosal melanomas: a population-based analysis. Int J Cancer. 2014;134(12):2961-2971.

Oliveria SA, Selvam N, Mehregan D, et al. Biopsies of nevi in children and adolescents in the United States, 2009 through 2013. JAMA Dermatol. 2015;151(4):447-448.

Rifkin JI, Shapiro H, Regensteiner JG, Stotler JK, Schmidt B. Why do some women refuse to allow male residents to perform pelvic exams? Acad Med. 2002;77(10):1034-1038.

Menees SB, Inadomi JM, Korsnes S, Elta GH. Women patients' preference for women physicians is a barrier to colon cancer screening. Gastrointest Endosc. 2005;62(2):219-223.

Houston NA, Secrest AM, Harris RJ, et al. Patient preferences during skin cancer screening examination. JAMA Dermatol. 2016;152(9):1052-1054.

Leffell DJ, Berwick M, Bolognia J. The effect of pre-education on patient compliance with full-body examination in a public skin cancer screening. J Dermatol Surg Oncol. 1993;19(7):660-663.

Krathen MS, Liu CL, Loo DS. Vulvar melanoma: a missed opportunity for early intervention? J Am Acad Dermatol. 2012;66(4):697-698.