Dermatologist Practices During Total Body Skin Examinations: A Survey Study
May 2018 | Volume 17 | Issue 5 | Original Article | 516 | Copyright © May 2018
Evan A. Rieder MD,a Euphemia W. Mu MD,a Jenny Wang BS,a David E. Cohen MD,a Darrell S. Rigel MD,a,b and Mary L. Stevenson MDa
aThe Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY bRigel Dermatology Group, New York, NY
Though screening for skin cancer is an essential practice in dermatology, limited data are published on dermatologists' total body skin examination (TBSE) behaviors. We surveyed 6500 dermatologists on their TBSE practices, including questions about less commonly examined body sites. We found varied TBSE practices among all dermatologists and discrepancies in examinations between dermatologists of opposite genders. J Drugs Dermatol. 2018;17(5):516-520.
Screening for skin cancer is an essential practice in dermatology.1 However, limited data are published on dermatologists’ total body skin examination (TBSE) practices,2 and no data are published on how TBSE practices vary by physician demographics. We report TBSE trends in a sample of U.S. dermatologists.A total of 6500 U.S. dermatologists who were part of a private online meeting planning group database were emailed a questionnaire assessing their TBSE practices, including questions about less commonly examined body sites, chaperone use, and barriers to practice. We assumed most dermatologists consistently examined the head, neck, trunk, and extremities, so examination of these areas was not queried. Statistical analyses were performed using Stata 11.0 for Mac (Stata Corp, College Station, TX). Categorical variables were compared with the χ2 test, and P values below 0.05 were significant.Of the dermatologists emailed, 623 responded (9.6%): 53% (n=331) males and 46% (n=288) females. Prior studies validate that our study sample size is large enough to be representative of the surveyed population. Standard statistical analysis for a suggested sample size of proportions with 95% confidence requires a target response rate of at least 363 respondents.3 Most respondents (77%) worked in private practice; 52% had practiced for at least twenty years. Providers reported examining the scalp, interdigital spaces, cutaneous lips, and nails in >75% of cases, the ocular canthi and bulbar conjunctiva in >50% of cases, and the oral mucosa and gingivae, palpebral conjunctiva, and external genitalia in <50% of cases. The scalp and genitalia were examined more often in male than female patients (P=0.001) (Table 1).Compared to male dermatologists, female dermatologists reported more frequently examining the scalp (P<0.001), interdigital spaces (P< 0.001), cutaneous lips (P=0.015), and nails (P=0.001; Table 2), but these differences in examination patterns normalized when physicians were sorted by years in practice. During examinations, practitioners reported utilizing chaperones infrequently: 47% of respondents reported always having a chaperone present, and 27% of respondents had a chaperone present for patients of the same sex (P<0.005). The greatest impediments to TBSEs included patient preference or refusal (reported by 85% of respondents), patient embarrassment (31%), and time constraints (30%). Patient embarrassment was the only impediment significantly different between practitioners of different genders (P<0.001, 40% of male dermatologists vs 19% of female dermatologists).Our survey found practice differences between male and female dermatologists. We speculate that differences in training, patient preference, and patient and provider comfort contribute to disparities in TBSE practices. Female providers may report more comprehensive examinations than their male counterparts due to recent increases in female dermatology residents and residency training initiatives emphasizing more comprehensive physical exams.4 Female practitioners also report seeing fewer patients per hour than their male counterparts, which may allow for additional examination time per patient.5In summary, we found varied TBSE practices reported in a large sample of U.S. dermatologists. Discrepancies exist in TBSE practices between dermatologists of opposite genders. Study limitations include small sample size, over-representation of later career practitioners, selection bias, recall bias, and an inability to account for the nature of the doctor-patient interpersonal interaction during clinical visit.