Total Body Skin Examination Research Articles

Total body skin examination visits by dermatology providers in the 2011-2016 National Ambulatory Medical Care Survey.

Total body skin examination visits by dermatology providers in the 2011-2016 National Ambulatory Medical Care Survey.

54016 Total-body skin examination rates among high-risk patients by insurance type: A National Health Interview Survey Study

54016 Total-body skin examination rates among high-risk patients by insurance type: A National Health Interview Survey Study

An Update on Cutaneous Angiosarcoma Diagnosis and Treatment.

Cutaneous angiosarcoma (CAS) is a rare aggressive malignancy that most commonly manifests in White men older than 60 years and often appears as an enlarging ecchymosis on the head, neck, or scalp. Surgery with negative margins is the first-line treatment. The role of Mohs micrographic surgery (MMS) is uncertain but can be used in smaller, well-circumscribed lesions on the head and neck. The greatest impact that dermatologists can have in the management of CAS is through a thorough total-body skin examination and heightened awareness resulting in a shortened time to diagnosis. Until quality evidence allows for the creation of consensus guidelines, multidisciplinary care at a cancer center that specializes in rare difficult-to-treat tumors is essential in optimizing patient outcomes.

Investigating effect of standardized total body skin examination using sequence-networks

This study employs sequence-network analysis to investigate the influence of instructing a standardized procedure on total-body skin examination (TBSE) performance. A between-subjects study was conducted with thirty-one participants comprising medical students and attending physicians. Among these participants, fifteen were randomly assigned to the uninstructed group and sixteen to the instructed group. The participants' gaze and field of view were recorded using eye tracking glasses while performing TBSE on a male and a female standardized patient. The recordings were then transcribed to depict the examination process. The instructed group missed significantly fewer body parts (p = 0.045) and had higher time efficiency (p = 0.007) while examining the female patient, but no significant difference was observed for the male patient examination. Furthermore, the examination sequences of the instructed group contained lesser variability than the uninstructed group. Hence, implementing a standard optimal procedure to perform TBSE could minimize the likelihood of missing body parts, increase examination efficiency, and improve performance consistency. This study demonstrated the potential of sequence-network analysis to study human performance in sequential tasks.

Prevalence of Total Body Skin Examinations among Dermatology Encounters in Medicare Data: A Retrospective Cohort Study

Prevalence of Total Body Skin Examinations among Dermatology Encounters in Medicare Data: A Retrospective Cohort Study

Finite element skin models as additional data for dynamic infrared thermography on skin lesions

ABSTRACT Skin cancer is a significant global health concern, with increasing incidence rates and a high number of deaths each year. Early detection plays a crucial role in improving survival rates, but current screening methods, such as total body skin examination, often lead to unnecessary invasive excisions. This research aims to explore the use of dynamic infrared thermography (DIRT) in combination with other technologies to potentially eliminate the need for biopsies in the future and gather information about the stage or depth of malignant skin lesions. The study involves data acquisition using a thermal camera and a finite element skin model. The FEM skin model employed in this research follows the commonly used five-layer model and is constructed in Siemens Simcenter 3D to be able to simulate the cryogenic cooling on the skin. It is possible to improve the thermal images by choosing an appropriate cooling method, cooling sequence and optimised measurement setup. While the FEM skin model shares certain similarities with the measurement data, there is room for further enhancements to optimise its performance. The acquired data is analysed to assess the effectiveness of the combined technique compared to existing clinical and diagnostic methods.

40583 Disparities in Total-Body Skin Examination among Sexual Minorities: NHIS 2015

40583 Disparities in Total-Body Skin Examination among Sexual Minorities: NHIS 2015

Draping in Dermatology: A Physician's Perspective.

Patient dignity is a core component of medicine and health care, yet maintaining patient dignity can be challenging in clinical settings in dermatology, specifically during a total body skin examinations (TBSE) for appropriate assessment and diagnosis. A recent study evaluated patient perspectives in dermatology. The purpose of this study was to investigate current draping practices and perspectives from a physicians' perspective. A cross-sectional study was performed with the use of study-specific questionnaire distributed to staff dermatologists and dermatology residents across Canada. A total of 117 physicians were included (84 attending dermatologists and 33 dermatology residents). Nearly all staff and resident dermatologists (90.6%) indicated that draping was important. Specific practices differed between residents and staff (P = .03). Only 3.1% of residents indicated that they did not receive any form of teaching on draping during their training compared to 21.4% of attending physicians (P = .03). This study confirms that draping practices in dermatology are perceived as important by dermatologists, consistent with other reports emphasizing approaches to protect patient privacy and dignity. There is a shared value for draping and consistent integration of this within current practice of Canadian dermatologists. Formal and informal education incorporated in medical education and dermatology training is becoming more prominent. Major study limitations include sampling bias, convenience bias and nonresponse bias. This is the first study to evaluate physician perspectives on draping in dermatology or other areas in medicine. Findings from this study support a focus on draping in medical education.

Utilizing eye-tracking software to evaluate the efficacy of standardized total body skin examination

Utilizing eye-tracking software to evaluate the efficacy of standardized total body skin examination

Impact of the COVID-19 pandemic on melanoma diagnosis and presentation: a `review.

The ongoing challenges posed by COVID-19 are concerning for their impact on successful detection and recognition of melanoma as total body skin examinations and skin biopsies are critical for identifying early-stage melanoma and intervening before progression to metastatic disease. A comprehensive electronic search of PubMed/MEDLINE was conducted on or before August 1, 2022, using the search terms ("skin" AND "COVID-19"), (["skin cancer" AND "COVID-19"] OR ["skin cancer" AND "coronavirus"]), (["melanoma" AND "COVID-19"] OR ["melanoma" AND "coronavirus"]), ("dermatology" AND "COVID-19"), and ("cutaneous" AND "COVID-19"). Eight articles representing Belgium, Chile, France, Germany, Spain, the United Kingdom, and the United States were included. Four articles analyzed changes in the proportion of in situ melanoma at diagnosis and consistently reported decreases, with an overall decrease ranging from 7.6 to 40.4%. Five studies analyzed changes in the proportion of melanoma diagnoses by staging, but no clear changes in staging patterns were observed. Five studies analyzed changes in the mean Breslow thickness of melanoma diagnoses and consistently reported increases, with an overall increase ranging from 4.0 to 38%. Disruptions to proper diagnosis and treatment of melanoma are creating undue morbidity, mortality, and healthcare costs as the pandemic continues. Continued research with improved, centralized data collection is needed to better address the COVID-19 pandemic's ongoing challenge to appropriate detection and treatment of melanoma.

Factors for not performing total body skin examinations in primary care in association with teledermoscopy

PurposeTo investigate factors related to omitted total body skin examination (TBSE) in skin cancer diagnostics while managing patients using teledermoscopy (TDS) in Swedish primary care.Methods4,987 TDS referrals from primary care centers were analyzed to identify factors associated with failing to perform TBSE. Data collected included age, gender of patient and physician, and reason for a visit. Logistic regression was used to test the association between the variables and risk of failing to complete a TBSE.ResultsThe risk for omitted TBSE is higher in older patients, females, patients whose primary reason for seeking care was not specifically for a complete skin check, and with female physician. Patients > 80 years had more than four times increased risk of not undergoing TBSE compared to the youngest (< 30 y). The strongest correlation to omitting TBSE was with other reasons for primary care visits than “skin check”. Male gender of the patient and being examined by male physicians decreased the risk of omitted TBSE by 20% and 30%, respectively. There was no evidence of interaction between the gender of the patient and the physician.ConclusionSince TDS reduces the opportunities to have a TBSE by dermatologists, the standard management of patients with suspicious skin lesions in primary care must be revised and evidence-based. TBSE is strongly recommended for patients with increased risk of skin cancer, for example old persons with fair skin and a history of skin cancer, when managing them with TDS.

Importance of a Total Body Skin Examination by Exposing a Patient for the Diagnosis of Tick-mediated Infectious Disease

An 81-year-old man was found unconscious in a bathtub by his wife after having taken a long bath. He was rescued by his wife and son, and they dressed him while calling for an ambulance. On arrival, he was in a shock state with convulsion. After exposing him, he was found to have multiple macular skin rashes with eschar with a red halo on his lower right abdomen. He was treated with anticonvulsant and massive infusion. He had had right lower abdominal skin lesions for more than two weeks, general fatigue and skin rash for one week, and a fever for four days before the arrival. A biochemical analysis of his blood on arrival indicated inflammation, hepatic, renal disturbance, and coagulopathy. As he had the triad of tick-mediated infectious diseases, he received minocycline. His general condition improved, and he regained his consciousness on day 6. On day 9, we obtained positive results for scrub typhus. Finally, he was discharged home. Physicians should perform a full body skin examination of patients with a coma or fever in order not to miss fatal diseases.

Skin Cancer Behavioral Risk Factors and Screening Among U.S. Adults in Same-Sex Relationships: A Population-Based Study from 2000 to 2015.

Purpose: Skin cancer is prevalent in sexual minority men but little is known about risk factors and screening specifically among couples in same-sex relationships (SSR). We aimed to compare sunburns, sun-protective behaviors, indoor tanning, and total body skin examinations (TBSEs) between people in SSR with those in opposite-sex relationships (OSR). Methods: We conducted a pooled cross-sectional analysis of 2000-2015 data from the National Health Interview Survey, a nationally representative survey of the United States civilian population. Results: Of 102,365 adults with a spouse or married partner, 448 (0.4%) were men in SSR, 48,312 (48.1%) men in OSR, 497 (0.5%) women in SSR, and 53,108 women in OSR (51.9%). Men in SSR were more likely than men in OSR to seek shade (adjusted odds ratio [aOR] = 1.41; 95% confidence interval [CI] = 1.07-1.85), tan indoors (aOR = 3.71; 95% CI = 2.38-5.78), and receive any TBSE (aOR = 2.45; 95% CI = 1.69-3.54) after adjusting for sociodemographic factors, health insurance status, and health behaviors. Men in SSR were less likely than men in OSR to wear long pants (aOR = 0.63; 95% CI = 0.46-0.85) and caps or visors (aOR = 0.50; 95% CI = 0.36-0.69). No differences in sunburns, sun-protective behaviors, indoor tanning, and TBSE between women in SSR and OSR were observed after multivariable adjustment. Conclusion: Patterns of sun-protective behaviors and indoor tanning among men in SSR, compared with men in OSR, demonstrate modifiable behaviors that may mitigate skin cancer risk. Dyadic counseling and public health interventions geared toward men in SSR may promote sun-protective behaviors and reduce indoor tanning.

Reminder Phone Calls Increase Total Body Skin Examination Compliance After Surgery in the Veterans Affairs Population: A Single Center Study.

Zakhem, George MD, MBA*; Wu, Julie MD*; Freedman, Jeremy MD*; Zampella, John MD* Author Information

Asymptomatic Umbilical Nodule.

A 64-year-old woman with no notable medical history was referred to our dermatology clinic with an intermittent eczematous rash around the eyelids of 3 months’ duration. While performing a total-body skin examination, a firm pink nodule with a smooth surface incidentally was discovered on the umbilicus.

33980 Skin cancer risk factors and screening among Asian Americans: Pooled cross-sectional surveys from 2000 to 2015

Asian Americans are underrepresented in health disparities research and little is known about skin cancer risk factors and screening among Asian Americans. We examined sunburns, sun-protective behaviors, indoor tanning, and total body skin examinations (TBSE) among Asian Americans as compared with non-Hispanic Whites. Cross-sectional survey data from the National Health Interview Survey were pooled from 2000-2015. Multivariate logistic regression models examined associations of skin cancer risk factors and screening with race. Models were weighed to provide nationally representative estimates and adjusted for survey year, sociodemographic factors, cancer-related health behaviors, and skin cancer history. Overall, 132,583 non-Hispanic Whites and 10,102 Asian Americans were included (2083 Chinese; 1928 Asian Indian; 2307 Filipino; 3784 other Asian). Asian Americans were more likely to seek shade, wear long clothing to ankles, and wear long-sleeved shirts but less likely to sunburn, apply sunscreen, tan indoors, and receive TBSE than non-Hispanic Whites (each P < .05). Asian Indians were less likely to sunburn (adjusted odds ratio 0.54; 95% CI 0.39-0.75) and more likely to wear long-sleeved shirts (1.54; 1.22-1.95) or long clothing to ankles (1.91; 1.53-2.40) than Chinese participants. Filipinos were more likely to engage in 1+ sun-protective behavior (1.30; 1.08-1.56) than Chinese participants. Limitations included self-reported data and no adjustment for skin tone. Asian American sun-protective behaviors may not be influenced by perceived skin cancer risk. Direct comparisons among Asian Americans subgroups revealed differences utilizable through culturally tailored interventions. Oversampling of Asian Americans will facilitate disaggregated analyses that may unmask health disparities among Asian American subgroups.

Draping in Dermatology: A Patient's Perspective.

Patient dignity is a core component of the Canadian health care system; however, there may be challenges to maintaining patient dignity in clinical settings requiring total body skin examination (TBSE) for adequate assessment and diagnosis. As standardized TBSE draping practices have not been investigated in a dermatology setting, we sought out to investigate subjective patient experiences of draping practices. A cross-sectional study was performed using a paper survey in dermatology hospital clinics over a 6-month period to 150 patients. Draping was considered important by over 50% of patients surveyed (54.7%). Respondents who indicated that draping impacted their comfort level "a lot" or "very much" had a mean age of 52 and were more likely to be females (P < .05). Females were also more likely to answer that their body weight/shape (P < .05), physician of same (P < .01) or opposite sex (P < .001), and the degree of privacy offered by drapes (P < .001) impacted their comfort level when undressing for a TBSE. Respondents who reported that any assessed factor impacted their comfort during a TBSE were also younger (P < .05), suggesting that younger and female patients were more likely to have comfort concerns than males. Our study confirmed that most patients surveyed considered draping to be important. Our findings highlight the importance of adequate draping practices to maintain patient privacy and dignity for all patients, with special attention to younger female patients to ensure they feel as comfortable as possible. Future research should focus on how these identified patient comfort factors can be implemented into medical education.

Development and Validation of a Simple Model to Predict the Risk of Nonmelanoma Skin Cancer on Screening Total Body Skin Examination.

Objective There is insufficient evidence to generate skin cancer screening guidelines at the population level, resulting in arbitrary variation in patient selection for screening skin examinations. This study was aimed at developing an easy-to-use predictive model of nonmelanoma skin cancer (NMSC) risk on screening total body skin examination (TBSE). Methods This epidemiologic assessment utilized data from a prospective, multicenter international study from primarily academic outpatient dermatology clinics. Potential predictors of NMSC on screening TBSE were identified and used to generate a multivariable model that was converted into a point-based scoring system. The performance characteristics of the model were validated in a second data set from two healthcare institutions in the United States. Results 8,501 patients were included. Statistically significant predictors of NMSC on screening TBSE included age, skin phototype, and history of NMSC. A multivariable model and point-based scoring system using these predictors exhibited high discrimination (AUC = 0.82). Conclusion A simple three-variable model, abbreviated as CAP (cancer history, age, phototype) can accurately predict the risk of NMSC on screening TBSE by dermatology. This tool may be used in clinical decision making to enhance the yield of screening TBSE.

Self-Assessment Questionnaire on Patient-Physician Concordance on Nevus Self-Count and Models Development to Predict High-Risk Phenotype >50 Nevi

Background: Cutaneous melanoma accounts for the majority of skin cancer-related deaths. Readily identifiable phenotypic characteristics and total body nevus count (TBNC) >50 are among the most important risk factors for cutaneous melanoma. Implementation of nevus self-count procedures and self-assessment of phenotypic traits as part of skin self-examination could be an excellent screening tool for identifying an at-risk target population. Objectives: Objectives of the study were to assess the skills of a central Italian and eastern Spanish population sample to recognize their skin lesions via the submission of a self-assessment questionnaire and to explore which self-assessment questionnaire item combination best predicts the high-risk condition of TBNC >50. Methods: Patients aged ≥18 years filled a self-assessment questionnaire, autonomously and prior to the dermatological visit. Subsequently, dermatologists performed total body skin examination and reported patients’ skin lesions on a separate questionnaire. Results: We reported fair to moderate patient-dermatologist agreement for skin lesion self-assessment. The item number of nevi on the back was the single questionnaire item most accurately predicting TBNC >50. The high-sensitivity and high-specificity classification and regression tree models for the prediction of TBNC >50 displayed different items combinations; the item nevus on the back was always the first and most important predictor in both our models. Conclusions: Patients were partially able to provide correct estimation of their whole-body nevus self-count. The item nevi on the back seems to be the first and most important predictor of TBNC >50 across our models. Delivery of high-sensitivity and high-specificity prediction models based on our questionnaire item combination may help defining a high-risk target population.

Skin cancers and their risk factors in older persons: a population-based study

BackgroundThe number of skin cancer is increasing rapidly. However, little is known about the risk factors of skin cancer in older persons. Our objectives were to determine the risk factors for skin cancer or its precursors in an older population. More specifically, to study the association of new skin cancers with previous skin cancer, sex, age, Fitzpatrick’s skin type, history of outdoor work and socioeconomic status (SES).MethodsIn this retrospective cross-sectional study of a large, well documented historical cohort data set a total body skin examination (TBSE) was performed for 552 participants aged between 70 and 93 years by dermatologists. The information gathered was augmented with health register data and self-reported data. The associations between skin cancer and its risk factors were studied by using the logistic regression analyses.ResultsAccording to the TBSE skin cancer/precursor was present in 25.5% of participants and was more common in males than in females (34.5% vs 20.2%, p < 0.001). Previous skin cancer increased the risk of subsequent skin cancer 2.6-fold (OR 2.56, 95% CI 1.43-4.55) and male sex nearly 2-fold (1.97, 95% CI 1.26-3.08). Specific risk factors for the first occurrence of skin cancer were male sex and outdoor work. There was also association between skin cancer and age and socioeconomic status.ConclusionsTBSE is recommend for physicians treating older persons to allow early recognition of skin cancers or their precursors. Older males need particularly close attention.