Melanoma screening by means of complete skin exams for all patients in a dermatology practice reduces the thickness of primary melanomas at diagnosis

Abstract

Objective: Previous studies have shown that dermatologists detect thinner melanomas than both non-dermatologists and patients in high incidence areas. The authors report depths of melanomas in a central New York practice where the incidence is low, hypothesizing that incidental melanomas detected by a dermatologist will be thinner than melanomas that are part of the chief complaint.

Design: A retrospective chart review examining melanoma depth to determine the importance of universal full skin exams.

Setting: Private dermatology clinic in Auburn, New York, employing one board-certified dermatologist and two physician extenders.

Participants: Men and women who attended the clinic between 2003 and 2013 who had 235 biopsy-proven melanomas. Total patient visits in this time period was 50,699.

Measurements: Office notes were reviewed to determine the chief complaint, patient demographics, and depth of the tumor. The authors noted if the melanoma was discovered by the patient, a referring physician, dermatology physician extender, or the dermatologist.

Results: More than 45 percent of melanomas were an incidental finding on full skin exam. The dermatologist detected statistically thinner melanomas than melanomas that presented as the chief complaint. The dermatologist tended to detect thinner melanomas than referring physicians and patients.

Conclusion: A significant portion of melanomas are incidentally found on full skin exam, and thinner melanomas are detected by dermatologists. Universal skin cancer screening takes little additional time, and appropriate use of physician extenders can greatly increase access to dermatological care. Full skin exams increase melanoma detection, decreases overall thickness at diagnosis, and decreases patient morbidity and mortality.

Figure 1

The average depths are compared for melanomas detected by dermatologists, physician extenders, non-dermatologic physicians, and patients. The dermatologist vs. physician extender comparison P=0.606. The dermatologist vs. non-dermatologic physician comparison P=0.055. The dermatologist vs. patient comparison P=0.025. Error bars display 95% confidence intervals for average depths.

Figure 2

The average melanoma depth discovered from full skin exams by the dermatologist is compared with the average melanoma depth when associated with the patients’ chief complaint. Error bars display 95% confidence intervals for the average depths. The two groups were statistically different with P=0.022.

Figure 3

This figure displays the comparison between average depth of invasive melanomas detected by the dermatologist and average depth of invasive melanomas that were part of the chief complaint with P=0.079.