November 1997

Screening for Skin Cancer in Primary Care Settings

Author Affiliations

From the Department of Medicine, Yale University School of Medicine, New Haven, Conn (Drs Federman and Concato); the Medical Service, West Haven Veterans Affairs Medical Center, West Haven, Conn (Drs Federman and Concato); and the Departments of Medicine (Dr Caralis and Mr Hunkele), Dermatology (Dr Kirsner), and Epidemiology and Public Health (Dr Kirsner), University of Miami School of Medicine, Miami, Fla.

Arch Dermatol. 1997;133(11):1423-1425. doi:10.1001/archderm.1997.03890470101016

Objective:  To estimate the frequency of recorded screening for skin cancer in primary care settings.

Design:  Retrospective observational cohort study.

Setting:  Two academically affiliated Department of Veterans Affairs Medical Centers.

Subjects:  Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics.

Main Outcome Measure:  Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period.

Methods:  Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits.

Results:  Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%); prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P<.001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination.

Conclusion:  Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.Arch Dermatol. 1997;133:1423-1425