Identifying incidental skin cancers following total body skin examination

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Conn McGrath

University of Oxford, UK

: J Clin Exp Dermatol Res

Abstract

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A significant proportion of skin cancers are diagnosed following a two-week-wait (2WW) referral in the UK. In our trust, total body skin examination (TBSE) is standard practice although the cost-effectiveness remains controversial. TBSE is reported to detect more skin cancers than lesion-directed examinations alone. This study aimed to quantify and characterize incidental lesions discovered from TBSE. A retrospective case-note review of 2WW clinic patients was undertaken (November 2014). Clinicopathological data for all incidental skin lesions were recorded. Overall, 361 patients were evaluated; 161 (45%) had incidental lesions (9% malignant) identified from TBSE; mean age 64y/o (range 15–98), 71% were fair-skinned, 25% reported prior history of skin cancer. 54% required reassurance alone, 31% required surgery and 15% required medical intervention e.g. cryotherapy. Overall, 10 incidental melanoma/melanoma in situ, 2 squamous cell carcinoma, 40 basal cell carcinoma and 16 pre-malignant lesions were identified. 28% incidental lesions were on the back compared with 14% index lesions, including 3/5 incidental melanomas. 86% (n=43) of biopsied incidental lesions were deemed to be of equal or greater severity in malignancy compared with their index lesion. Our study demonstrates that TBSE identifies an additional 9% of skin malignancies, comparable to figures reported in the literature. With rising patient demand and long waiting lists, teledermatology is increasingly being used, thus reducing TBSE being performed by an expert dermatologist. We highlight the importance of TBSE in standard care of patients attending 2WW skin cancer clinics who are at high risk of second primary cutaneous malignancies.

Biography

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E-mail: connajmcgrath@gmail.com