Should the Skin be Examined Fully When the Patient Points out a Single Lesion ?

Total-Body Examination vs Lesion-Directed Skin Cancer Screening.
Hoorens I, Vossaert K, Pil L, Boone B, De Schepper S, Ongenae K, Annemans L, Chevolet I, Brochez L.
JAMA Dermatol. 2015 Oct 14. doi: 10.1001/jamadermatol.2015.2680. [Epub ahead of print]

A common thing to ask to a dermatologist is to perform a “skin check” or to have the moles and rest of the skin on the body checked.

Some patients only want to show one mole/lesion and they do not wish to have the rest examined

This study shows that the rate of detection of malignant melanoma and other common skin cancers is the same whether the skin is examined fully or if one lesion is examined.

In this study from Belgium 2 groups of patients were recruited by a team of 6 dermatologists:
–systematic total-body examination (TBE) in 9325 inhabitants of a town in Belgium. The population received a standard invitation for the screening
–lesion-directed screening (LDS) in 9484 of another town in Belgium (similar socio-demographics). Individuals were invited for an LDS if they had a lesion meeting 1 or more of the following criteria: ABCD rule (A, asymmetry; B, borders; C, colors; and D, differential structures), ugly duckling sign, new lesion lasting longer than 4 weeks, or red non healing lesions

Results
47 skin cancers were detected (9melanomas, 37 basal cell carcinomas, 1 Squamous Cell Carcinoma, 1 Bowen’s disease (no difference in the rate (%) of detection between the 2 groups although naturally higher absolute numbers were found in TBE group as more participants were examined.
-TBE Group Only 314 of the 9484participated 3.3%
-LDS Group 1668 of the 9325 invited inhabitants particpated (17.9%)

Conclusion: This study does show however that this method yields similar melanoma and keratinocyte carcinoma (Basal Cell Carcinoma, Squamous Cell Carcinoma; old term=non-melanoma skin cancer (NMSC))) detection rates and that it is 5 times less time consuming. The authors conclude that it could be a solution in strained medical systems: either by cost or if the demand is too high

Comments:
1. We could say that examining a specific lesion is enough in order to save time…however this is not good medical practice for the following reasons;
-skin phototype gives the ‘risk level” of the skin as a whole to develop skin cancer.
-patients don’t see all their lesions (for example: the back)
-examining the skin as a whole also enables to detect other skin conditions.
2. A 5-fold fewer number of participants accepted to have an LDS when invited to do so as when compared with TBE. Our impression is that the quality of LDS skin checks even if performed by dermatologist is perceived as lower.

3. The image of the dermatologist is also tarnished by patients who could feel that they are not taken care of properly.

Article selection: Prof Dr Jean-Hilaire Saurat – dermatologist. Geneva, Switzerland