Identification of Incidental Skin Cancers Among Adults Referred to Dermatologists for Suspicious Skin Lesions

ABSTRACT: Key Points

Question

What is the rate of incidental skin cancer detection in urgent skin cancer clinics, and are incidental cancers more likely to be detected in patients with a clinically suspicious index lesion than in those without?

Findings

In a cohort study including 4726 patients, 1117 malignant lesions were detected, 22% of which were identified incidentally by total body skin examinations corresponding to an incidental lesion detection rate of 5.1%. Detection of a malignant incidental lesion by total body skin examinations was significantly more likely in patients presenting with an index lesion suspicious for malignancy, compared with patients who presented with index lesions judged to be clinically benign.

Meaning

The findings of this study suggest that total body skin examinations may be useful for detecting incidental skin cancers and that patients with suspicious index lesions should be prioritized.

Importance

The incidence of skin cancer is increasing and evaluation of the utility of total body skin examination (TBSE) in detecting incidental skin cancers is warranted.

Objectives

To evaluate the proportion and rate of incidental skin cancer detection in urgent skin cancer clinics and investigate the rate of incidental skin cancer detection in 2 groups based on the degree of clinical suspicion of the index lesion for malignancy.

Design, Setting, and Participants

A multicenter retrospective cohort study with a case note review of consecutive secondary care consultations was conducted using data from 2 urgent suspected skin cancer screening clinics in UK National Health Service trusts. The study was performed from January 1, 2015, to March 31, 2016, and data analysis was performed from October 14, 2018, to February 1, 2019. Patients included those presenting with a skin lesion suspicious of malignancy who were referred to the urgent suspected skin cancer clinic (N?=?5944) over 15 months. Patients who accepted and received a TBSE were subsequently included in the analysis.

Main Outcomes and Measures

The proportion and rate of incidental skin cancer detection through TBSE and whether a clinically suspicious (malignant) index lesion was associated with a higher chance of having a malignant incidental lesion.

Results

Of the 5944 patients referred to the clinic, 4726 individuals (79.5%) were evaluated. In the cohort included in the analyses, the median age was 57 years (interquartile range, 39-73 years); 2567 patients (54.3%) were women. A total of 1117 skin cancers were identified; of these, 242 lesions (21.7%) were detected incidentally through TBSE, including 197 of 570 (34.6%) basal cell carcinomas, 16 of 250 (6.4%) squamous cell carcinomas, and 25 of 215 (11.6%) melanomas. The detection rate of incidental malignant lesions was 5.1 lesions per 100 patients examined (5.1%; 95% CI, 4.5%-5.8%). There was a higher detection rate of histologically confirmed incidental malignant lesions in individuals with clinically suspicious index lesions requiring biopsy (10.9%; 95% CI, 9.5%-12.5%) compared with those presenting with clinically benign index lesions (2.0%; 95% CI, 1.6%-2.5%) (P?Conclusions and Relevance The findings of this study support the use of TBSE for urgent skin cancer referrals, highlighting the potential harms of solitary lesion assessment in a subgroup. Individuals presenting with a clinically suspicious index lesion requiring biopsy are most likely to benefit from TBSE and should be counseled regarding the benefit. This cohort study examines the use of total body skin examinations for detection of incidental skin cancers in patients referred to dermatology clinics for evaluation of a clinically suspicious index lesion.

SUBMITTER: Omara S 

PROVIDER: S-EPMC7745102 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature