Time Required for a Complete Skin Examination With and Without Dermoscopy

Abstract

There is ample evidence that early detection of skin cancer can be facilitated by performing a complete skin examination (CSE) and by using dermoscopy.^1-16 The advantages of dermoscopy as an addition to the naked-eye skin cancer screening are numerous but can be summarized as follows: improved diagnostic sensitivity for melanoma and nonmelanoma skin cancer¹² and reduced biopsy rate of benign skin lesions.¹⁶ Although the US Preventive Services Task Force¹⁷ does not currently recommend routine CSE, claiming a lack of evidence for its efficacy in reducing mortality rates, recent studies reveal that a higher proportion of thinner melanomas are being detected during skin cancer screening than previously suggested.^5-7,18 Furthermore, melanoma mortality rates appear to be leveling off, and because few advances have been made in the treatment of advanced-stage disease it is reasonable to assume that this effect is primarily due to early detection.¹⁹ Based on the aforementioned statistics, it would seem reasonable to encourage the opportunistic screening of individuals at risk for developing skin cancer. Unfortunately, most physicians do not endorse the concept of opportunistic screening of their patients for skin cancer because of a lack of evidence for its efficacy, lack of reimbursement, patients' embarrassment, and a lack of time, among other factors.^20-24 It is interesting and troubling to note that most melanoma patients have had at least 1 medical visit in the year before their melanoma diagnosis, yet only 20% of them reported receiving a skin cancer examination during that visit.²⁵