Examenes Cutáneos completos

Los canceres de piel, se detectan durante los exámenes cutáneos completos y es por esto que se deben realizar por lo menos una vez al año. La publicación de abajo justifica con números...Published in Dermatology

Expert Opinion / Commentary · February 22, 2016

The Case for Total Body Skin Examination: The Evidence Is Sufficient

Written by

 

 Jane Grant-Kels MD

 Save Recommend

 Share 

The recommendation by the USPSTF is mind boggling (http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement168/skin-cancer-screening2)! Skin cancers are on the rise in our country, resulting in potential mutilation and even death if not diagnosed early! There is absolutely no denying the fact that skin cancer is now of epidemic proportions, with increasing numbers every year. The 2015 estimate in the United States alone is 5.4 million cases of treated non-melanoma skin cancer (NMSC).1 Those who participated in penning the conclusion of this USPSTF recommendation have not accepted the reality that there are more new skin cancers treated in the United States (not only this year but over the last 3 decades) than all other cancers combined! 2,3 The National Cancer Institute has reported that between 40% and 50% of Americans who live to the age of 65 years will develop a NMSC at least once.4

Some might counter with the argument that skin cancer, although the most common cancer, is not generally life-threatening. I would retort that this is due to continued vigilance and skin screening performed by dermatologists. Nevertheless, despite our best efforts, 2% of patients in the United States diagnosed with cutaneous squamous cell carcinoma will die annually from their skin cancer.5 Additionally, approximately 3000 patients with advanced basal cell carcinoma will die this year of metastatic basal cell carcinoma.6 Finally, 1 American expires every 57 minutes in the United States from malignant melanoma.7

I have been practicing dermatology for almost 40 years. The majority of patients I care for do not get full skin cancer examinations by their primary care physicians. The skin cancers that I diagnose are generally asymptomatic, and the patients and their partners are completely unaware of these lesions. Publications by others have substantiated my own experiences. For example, Daniel Federman's group noted that incidental skin cancers were identified by a full skin exam performed by a dermatologist who, in addition to examining the specific lesion on the patient referred to them by a primary care physician, also performed a total body skin examination. They concluded that there was no substitute for complete skin examinations.8

Erin Washaw and her group in Minnesota published their findings this year regarding the rate of incidental cutaneous malignancies on routine dermatology exams at a Veterans Affairs medical center. They performed a retrospective chart review and found that, of 17,174 dermatology exams, over 13% of the patients had an incidental lesion biopsied—of which, 50.3% were malignant, leading them to conclude that an in-person skin examination by a dermatologist was still the standard of care.9

Lastly, a 2013 study from the University of Edinburgh also stressed the importance of a total body skin examination. These authors reported that over one-third of melanomas are detected as incidental lesions on complete skin examination.10

The take-away message is clear: a total body skin examination must be performed annually on all patients and, if discontinued, will likely lead to melanomas and NMSCs being missed. I would favor more educational opportunities for family and internal medicine physicians regarding the skin so that they can perform these full skin exams as part of their annual screenings of their patients. High-risk patients should then be appropriately referred to dermatologists for further and specialized surveillance.