Skin Cancer Screening Practices Among Dermatologists: A Survey Study

November 2022 | Volume 21 | Issue 11 | 1235 | Copyright © November 2022


Published online October 27, 2022

Yanci A. Algarin BSa, Catherine McCullum MDb, Vishal A. Patel MDb

aEastern Virginia Medical School, Norfolk, VA
bDepartment of Dermatology, The George Washington School of Medicine and Health Sciences, Washington, DC

#These authors contributed equally to the work.

Abstract
Background: The United States Preventative Task Force (USPTF) has concluded that the benefit of skin cancer screenings is inconclusive. A systematic review found that implementing skin cancer screening increased detection of in situ and thin melanoma, increased incidence of non-melanoma skin cancer detection, and decreased rates of thick melanoma. However, only one of the studies reviewed found a reduction in melanoma mortality. Evidence is notably unclear for the exact benefits of preventative skin cancer screening.
Objective: This study intends to discover the current skin cancer screening practices and recommendations of dermatologists.
Methods: A 20-question “Skin Cancer Screening Survey” was developed and sent to the American College of Mohs Surgery.
Results: 124 dermatologists completed the survey. The majority of physicians (77.4%) said they perform routine skin cancer screening exams. 37.9 % of respondents noted that they recommend routine skin cancer screenings to all their patients, while 27.4 % of participants recommend screening only patients with a risk factor. Most of the respondents (52.4%) stated that they do not follow any specific guidelines regarding routine skin cancer screenings. The majority selected that they usually perform full body skin exams (69.4%). Of those who answered that they do follow guidelines, most followed the American Academy of Dermatology guidelines (48.5%). 42.7% of respondents were aware of the USPTF recommendations regarding routine skin cancer screening.
Discussion: The results demonstrate variability in real world practice of skin cancer screening exams. There is imperative need for evidence-based uniform guidelines to drive accurate and unbiased preventative practice behaviors in the United States.

J Drugs Dermatol. 2022;21(11):1235-1241. doi:10.36849/JDD.6660

INTRODUCTION

Skin cancer is more common than all other cancers combined, and its incidence is rising faster than that of any cancer.1 The American Cancer Society estimates that 5.4 million basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) are diagnosed each year, and an estimated 100,350 new invasive melanomas will be diagnosed in 2020.2,3 Skin cancer screening is a tool used by dermatologists to detect these cancers; however, evidence of its utility has been mixed. The United States Preventative Task Force (USPTF) has concluded that there is currently not enough evidence to suggest that skin cancer screening is beneficial.4

A systematic review on the impact of skin cancer screening found that implementing skin cancer screening increased detection of in situ and thin melanoma, increased incidence of non-melanoma skin cancer detection, and decreased rates of thick melanoma. However, only one of the studies reviewed found a reduction in melanoma mortality. The evidence level is notably unclear for the exact benefits of preventative screening.5 Due to this uncertainty, some academic cancer centers are narrowing their guidelines for whom is recommended to undergo routine skin cancer screening.6,7 This study intends to discover the current skin cancer screening practices and recommendations of dermatologists.

MATERIALS AND METHODS

A 20-question "Skin Cancer Screening Survey" was developed and sent to the American College of Mohs Surgery and the Association of Professors of Dermatology email listservs. Demographic information was obtained on the type of practice and length of practice, excluding residency. The survey asked participants questions regarding how often they performed skin cancer screenings and how often they recommended skin cancer screenings to their patients. Information was also obtained on what areas of the body they typically examined, the use of dermoscopy, the use of total body photography (TBP), and if they recommended self-skin cancer screenings.

The study was approved by the institutional review board of George Washington University, Washington DC and a waiver was approved. The survey was administered via SurveyMonkey. Invited participants were emailed a link to the survey, which was followed up with one additional reminder over the course of 4 weeks.