Melanoma Screening by Means of Complete Skin Exams for All Patients in a Dermatology Practice Reduces the Thickness of Primary Melanomas at Diagnosis

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.Melanoma is the most deadly type of skin cancer with limited treatment for deep tumors. The average age adjusted melanoma death was 2.73 per 100,000 in the United States between 2006 and 2010.1 Thus, early detection of melanoma offers the best hope for a cure. Cutaneous melanoma presents a unique opportunity for intervention compared to other malignancies, as screening is simple, noninvasive, and takes little time. Clinical full skin exams have been shown to decrease the number of deep melanomas,2 which is important because the depth of invasion for malignant melanoma is the most important prognostic factor. However, even with the availability of such an easy screening test, the guidelines of when and whom to screen are unclear.3 The effect of screening on patient mortality has not been studied in a randomized trial, and formal guidelines are lacking. Previous studies have attempted to determine who detects melanomas and how they present in their clinics.2,4–6 Several of these studies were performed in areas of higher incidence of melanoma, such as Australia2 and Florida.6 The aim of this study is to report the percentage of the authors’ patients incidentally found to have melanoma as part of a full skin exam and to compare the depth of invasion with patients whose melanoma was related to their chief complaint. The authors compare their data from a private practice near Syracuse, New York, which has a relatively low incidence of melanoma in the United States,1 to some of the previously reported studies and make recommendations for future screening.