Skin cancer screening: Quick, effective -- and neglected

Conflicting guidelines on screening for skin cancer as well as primary care physicians' lack of confidence in detecting suspicious lesions could hinder broader use.

By Susan J. Landers, AMNews staff. June 14, 2004.

Washington -- Patients understand the importance of a top-to-toe and back-to-front skin exam for early detection of cancer, and they even believe a physician who performs full-body skin screens is admirably thorough.

But not very many primary care physicians are doing them, according to several studies.

"In primary care, visits are so compact with issues from disease management to immunizations to other prevention that physicians will often neglect simple skin cancer screening," said Daniel G. Federman, MD, a primary care physician at the Veterans Administration Hospital in West Haven, Conn. He would like to see that situation change.

Preventive care that includes other cancer screenings is finding a proper niche in the offices of primary care physicians, and many ask, why not skin cancer screening, too?

Skin cancer is the most common malignancy in the United States, and it could be the ideal cancer for screening, since many risk factors are well known and there are opportunities for early detection, note Dr. Federman and colleagues in a May article in the Archives of Dermatology. Approximately 85% of the population sees a physician every two years, and routine examinations are among the 10 most common reasons for patient visits, they write.

For his most recent study, Dr. Federman and colleagues asked 251 patients whether their physicians had checked their skins and also asked the patients how they felt about it. "Some people might think it's a little weird if they have a wart and someone asks them to get naked," he said. But the researchers found that patients were accepting.