Complete skin examination is essential in the assessment of dermatology patients: findings from 483 patients

Summary Background  Dermatological teaching has traditionally stressed that complete skin examination is essential in the assessment of patients with potential skin disease. Objectives  To determine whether complete skin examination results in increased diagnoses of skin malignancies that would not have been discovered otherwise. Methods  New patients ( n  =   483) attending a dermatology clinic in a university teaching hospital and private dermatology practice had a complete skin examination, as is our normal practice. These patients were seen over a 9‐month period (January–September 2009). All patients were examined by the same consultant dermatologist. Data were collected on patients’ sex, age, presenting complaint and findings on complete skin examination. Results  Two nodular malignant melanomas with mean Breslow thickness of 0·6 mm (0·4%) and one melanoma in situ were identified at sites distant from the patient’s presenting complaint. Sixteen patients (3·3%) had a basal cell carcinoma that would not have been discovered if the presenting lesion alone had been examined. Thirty‐three patients (6·8%) had actinic keratoses or squamous cell carcinoma in situ and nine (1·9%) had dysplastic naevi. A further 21 patients (4·3%) had a suspicious lesion biopsied or excised with subsequent benign histology. Seventy‐three patients (15·1%) had other benign dermatological diagnoses requiring treatment or investigation. Conclusions  In a 9‐month period, in a sample of 483 new patients, three patients (0·6%) had potentially lethal skin malignancies identified that would not have been diagnosed without a complete skin examination. Sixteen (3·3%) patients had basal cell carcinomas that would have been missed without complete skin examination. This study confirms the traditional teaching that complete skin examination has the potential to reduce morbidity and mortality from cutaneous malignancy.