(May 2011) Here’s one good reason to go to a specialist for a total body skin exam (TBSE): Non-specialists miss many cancerous skin lesions, and only a TBSE by a dermatologist can ensure they will be detected, according to findings from a new study from the Yale School of Medicine and Yale Medical Group.
The findings also suggest the increasingly common use of teledermatology (in which non-specialists communicate skin conditions to a dermatologist long-distance via audio, video and data techniques) has the potential to miss many cancerous lesions. The study appears in the Archives of Dermatology.
More than one million skin cancers are diagnosed each year in the United States, and one in five Americans will develop skin cancer in their lifetime. Non-specialists, especially primary care physicians, are often the first to see skin lesions, initiating referral to dermatologists.
The Yale research team studied the records of 400 patients referred by non-specialists to the dermatology service at the Veterans Affairs Connecticut Healthcare System. Each of the patients each had one lesion considered suspicious for malignancy.
Of the 149 lesions that proved to be malignant, 41 percent were incidental — meaning that they were not originally detected by the non-specialist but were picked up in the total body skin exam. Among these incidental lesions discovered by the dermatology service, six turned out to be malignant melanomas — the most deadly form of skin cancer.
"Our research demonstrates how important it is to perform a total body skin exam, because the earlier a lesion is diagnosed, there is a more likely chance of complete recovery," said senior author Daniel G. Federman, MD, professor of internal medicine at Yale School of Medicine and firm chief, primary care, at the Veterans Affairs Health Care System in West Haven, Connecticut.
The authors also caution about the use of teledermatology, which was originally utilized in rural areas but has gained momentum even in highly populated areas over the past decade. It's associated with decreased time to diagnosis and surgical treatment. But because it utilizes digital images instead of total body skin exams conducted in-person, the reviewing dermatologist may not see malignancies or other lesions of concern outside the field of the digital image.
"Teledermatology clearly has a role in areas where patients do not have access to dermatologists," Dr. Federman explained. "Our findings suggest non-dermatologists should receive more training in the diagnosis of skin cancer, and both non-dermatologists and dermatologists should perform a full body skin examination if they find a suspicious skin lesion during a patient encounter."
Other authors were Cary P. Gross, MD, of Yale Medical Group; Suguru Imaeda, MD, of Yale Medical Group and the Veterans Affairs Health Care System; Whitney L. Tolpinrud of Yale School of Medicine; Robert S. Kirsner, MD of the University of Miami School of Medicine; and Kate V. Viola, MD, formerly of Yale School of Medicine and currently of the Albert Einstein College of Medicine and Montefiore Medical Center. The study was funded by the Robert Wood Johnson Clinical Scholars Program at Yale, and West Haven Veterans Affairs.
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