TOTAL BODY SKIN EXAMINATION
By Gary M. White, MD
Various factors may indicated the need for a total body skin examination, including the presence of many moles.
Total body skin examination (TBE) by a dermatologist aided by the dermatoscope is the current gold standard. TBE may take anywhere from 1 to 6 minutes depending upon the number of moles and whether dermoscopy is used. How many TBSEs are needed to find one melanoma? The answer depends largely on the risk factors of the population screened. In Italy, 5002 people screened yielded 10 melanomas (1 in 500) [Eur J Cancer Prev. 2012 Jan;21(1):89-95]. In the UK, 832 people were screened to find 3 melanomas--1 in 277 [Br J Dermatol. 2001;145:784].
- Always look in the scalp for any older patients, especially if they have thinning hair.
- Often, examination of the genitalia is excluded.
- The USPSTF concludes there is insufficient evidence to recommend widespread complete skin exams for individual without risk for melanoma.
Who should receive a TBE?
In the ideal world, everyone would get a TBE by a dermatologist each year. However this is not practical. Thus, resources should be focused on those at highest risk for skin cancer. For example, anyone seeing a dermatologist should be encouraged to have a TBE if they have any of the following (list is not exhaustive, merely illustrative):
- Prior history of skin cancer.
- They are referred for a skin tumor or a suspicious lesion is found in the problem area.
- Caucasian, male and over 65.
- Significant sun damage of exposed skin.
- Transplant patient
- A large number of moles.
- Multiple, first-degree relatives with melanoma.
- History of visit to a tanning booth more than 20 times.
If a skin tumor is the reason for a consultation or if a suspicious lesion is found at the problem area the risk of missing a skin cancer significantly increases when no additional TBE is performed [Total-Body Examination vs Lesion-Directed Skin Cancer Screening JAMA Derm online first October 14, 2015].
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