Outcomes of dermatologist-performed skin cancer screening in an academic setting: A retrospective cohort study

Early detection of skin cancer improves outcomes, but the utility of dermatologist-performed total body skin examinations (TBSEs) in unselected populations remains uncertain.

To evaluate the diagnostic yield, biopsy burden, and temporal trends of dermatologist-led TBSEs in an academic screening program.

This retrospective cohort included 3127 encounters from 1572 University of Miami employees and spouses who underwent annual TBSEs between January 2019 and June 2024. Primary outcomes were detection of premalignant (actinic keratoses) and malignant lesions (basal cell carcinoma, squamous cell carcinoma, and melanoma). Secondary outcomes included number needed to biopsy, predictive value of patient-reported lesions, and changes across screening rounds.

Across TBSEs, premalignant, in situ, and malignant lesions were detected in 11.0%, 0.22%, and 2.6% of examinations, respectively. Of the screenings with malignant findings, 69 found basal cell carcinoma, while 12 found squamous cell carcinoma. Detection was highest among older adults and those with prior nonmelanoma skin cancer. Patient-reported "spots of concern" had low predictive value (positive predictive value 2.7% for premalignant, 0.5% for in situ, and 1.2% for malignant). Overall number needed to biopsy was 4.83, improving from 6.10 to 2.79 across rounds.

Participation was voluntary, introducing selection bias; biopsy practices varied, and external procedures may have been missed.

Dermatologist-performed TBSEs identified early-stage skin cancers, with higher yield in higher-risk groups.