The importance of palpation in the skin cancer screening examination

With the recent unprecedented shift toward contactless healthcare solutions, providers should recall the value that proper palpation adds to dermatologic practice. We present a case that demonstrates the limitations of touchless care and how proper palpation during skin cancer examinations may impact cosmetic outcomes. Our patient is an 86-year-old male patient with Sezary syndrome and monoclonal B-cell lymphocytosis whose squamous cell carcinoma invasion was missed by visual inspection alone. He delayed treatment of his biopsy-proven squamous cell carcinoma for 15 months. On follow-up, visual examination only showed a well-healed biopsy scar, and treatment was delayed another 2 months. Finally, thorough physical examination found perineural invasion. This helped guide the Mohs approach, but due to the delays resulted in a larger final defect and poorer cosmetic outcomes. Proper, deep palpation of skin lesions, especially prior biopsy sites, is imperative to the treatment of skin cancer in cosmetically sensitive areas. Biopsy scars on the face often heal well, and visual only inspection may miss crucial details. This case also reminds dermatologists of the importance of patient education in the prompt treatment of skin cancer for the best cosmetic outcomes.