Beschreibung:
<jats:p> 10078 </jats:p><jats:p> Background: The clinical efficacy of the total body skin exam has long been the subject of debate. A 2016 report by the United States Preventative Services Task Force (USPSTF) found the current body of evidence was “insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in [asymptomatic] adults.’’ However, the USPSTF based its recommendations on studies evaluating mainly the ability of primary care physicians to diagnose melanoma through total body skin exams (TBSE). This study seeks to address this insufficiency in the current literature by exploring the clinical efficacy of the dermatology provider performed TBSEs as a screening tool with respect to the detection of malignant melanoma (MM), squamous cell carcinoma (SCC), and basal cell carcinoma (BCC). Methods: A search was performed within the electronic medical record of a large multi-state dermatology group practice for all instances of new and established patient office visits occurring from 1 January 2018 to 31 December 2019. Per practice policy, it is denoted whether each office visit includes a TBSE or partial skin exam (PSE). The number of MM, SCC, and BCC diagnoses made within the context of each class of skin exam was analyzed. Results: Of the 930,706 office visits analyzed, 438,027 TBSEs and 492,679 PSEs were performed. For each of the three types of skin cancer surveyed, the number of cancers diagnosed in the context of a TBSE was significantly greater than the number diagnosed in the context of a PSE. One MM was diagnosed per 161.0 TBSEs and 371.3 PSEs ( Χ<jats:sup>2</jats:sup> ( df = 1, N = 930706) = 662, p < 0.001). One SCC was diagnosed per 56.7 TBSEs and 108.4 PSEs ( Χ<jats:sup>2</jats:sup> ( df = 1, N = 930706) = 1258.5, p < 0.001). One BCC was diagnosed per 10.2 TBSEs and 17.8 PSEs ( Χ<jats:sup>2</jats:sup> ( df = 1, N = 930706) = 5884, p < 0.001). Conclusions: Skin cancer is detected at significantly higher rates in TBSEs than PSEs. The finding that one MM is detected in 161 TBSEs may be compared to one cervical cancer is detected in 3,776 Pap smears. Thus, a TBSE is 23.5 times more likely to identify a MM than a Pap smear is to identify a cervical cancer. This trend holds even when adjusted for prevalence. Further analysis will allow for the comparison of exam types with respect to patient age, staging, lesion size, and Breslow depth at time of cancer diagnosis. This continued analysis will allow for a more detailed risk benefit-analysis and insight into the clinical efficacy of the TBSE. </jats:p>