Standardized Total Body Skin Exam: Improved Accuracy and Efficiency?
Posted: Monday, July 1, 2019
The total body skin exam is a standard of care for the detection of skin cancers. In a study published in the Journal of the American Academy of Dermatology, researchers used applied engineering principles to develop a standardized total body skin exam to improve the accuracy and efficiency of the physical exam. According to Jeffrey J. Miller, MD, of the Penn State Health Hershey Medical Center in Hershey, Pennsylvania, and colleagues, there is currently no standardized method for performing a total body skin exam, resulting in redundancy, unnecessary movements, and/or missed areas.
“Efficiency and accuracy are important because we do a lot of total body skin exams every day,” stated Matthew F. Helm, MD, in a Penn State press release. “However, we do not want to sacrifice accuracy for efficiency.”
In this observational cohort study, the researchers observed five dermatology faculty members and five dermatology residents conducting their regular total body skin exams. The time to perform the exam ranged from 75 to 243 seconds, and there was significant variability between providers in their efficiency and order of examination. The neck was the area with the highest frequency of being missed during exam (29.5%), followed by the underarm region (13.6%). The average efficiency for the examination of male and female individuals was 66.3% and 74.7%, respectively, indicating that about 33.7% and 25.3% of the time for male and female exams, respectively, was wasted on unnecessary movements.
The proposed optimal standardized total body skin exam begins with the patient sitting while the dermatologist examines the anterior face, scalp, neck, chest, flank, stomach, arms, hands, legs, and feet of the patient. The patient then stands and turns away from the examiner to have the posterior scalp, neck, back, posterior arms, and legs examined.
Disclosure: The study authors reported no conflicts of interest.