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Screening for skin cancer in primary care settings
D G Federman1, J Concato, P V Caralis
1Department of Medicine, Yale University School of Medicine, New Haven, Conn., USA.
Objective:
To estimate the frequency of recorded screening for skin cancer in primary care settings.
Design:
Retrospective observational cohort study.
Setting:
Two academically affiliated Department of Veterans Affairs Medical Centers.
Subjects:
Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics.
Main Outcome Measure:
Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period.
Methods:
Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits.
Results:
Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%), prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P < .001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination.
Conclusion:
Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.