A majority of dermatologists, internists, and family physicians routinely perform full-body examinations for skin cancer – but time constraints and patient reluctance are common barriers to better exam rates, according to a report in the January issue of the Archives of Dermatology.
A total of 81% of dermatologists, 56% of internists, and 60% of family physicians in a nationally representative sample reported that they routinely perform the skin cancer examinations.
All three groups of physicians also identified barriers to performing skin examinations more often, but the barriers varied by specialty, said Susan A. Oliveria, Sc.D., of Memorial Sloan-Kettering Cancer Center’s dermatology service, New York, and her associates (Arch. Dermatol. 2011;147:39-44).
The investigators assessed skin cancer screening practices because little is known about the subject, and a better understanding both of the obstacles and of the facilitating factors could help improve primary and secondary screening.
To examine the issue, the researchers used data from a survey to which 1,669 physicians in group or solo private practice responded. The respondents included 679 dermatologists, 431 internists, and 559 family physicians. Most reported that they saw 200-600 patients per month, and most were aged 41-60 years.
Approximately 54% of internists and family physicians reported that time constraints prevented them from doing full-body skin exams more frequently, compared with only 31% of dermatologists. Half of the internists and family physicians also said that "competing comorbidities" often took priority over skin exams, compared with only 16% of dermatologists.
In contrast, significantly more dermatologists (44%) identified patient embarrassment or reluctance as a barrier to performing full-body skin exams, compared with internists (33%) or family physicians (31%). That is likely because most patients see a dermatologist for an isolated skin condition such as a wart or rash, the investigators noted, and do not expect to undress for a full-body exam.
In contrast, patients expect to undress for an internist or family physician, because disrobing for pelvic or rectal exams often is part of their annual physical examinations. Moreover, primary care physicians "have years to build up relationships with their patients," the study authors explained, while dermatologists typically do not.
To overcome that barrier, "dermatologists could educate their patients about the role of a full-body skin examination in a routine visit by providing them with written material to read and establishing a comforting physician-patient relationship," Dr. Oliveria and her colleagues said.
All the physicians reported that they were more likely to screen for skin cancer in patients who had one or more risk factors for the disease. Even so, only 87% of dermatologists, 65% of internists, and 70% of family physicians reported that they performed full-body exams in most of their high-risk patients.
Another common reason for performing a full-body skin cancer screen was the same for all three specialties: having a patient ask to have such an exam or to have a suspicious mole checked. That shows that it is important to maintain public education programs encouraging patients to request skin exams or mole checks, the researchers said.
Fewer internists (56%) and family physicians (54%) than dermatologists (78%) reported that their skill and expertise at performing skin exams and diagnosing skin cancer facilitated their screening practices. That finding suggests that enhanced dermatologic training during medical school and continuing medical education programs would be beneficial, the investigators added.
The National Cancer Institute supported the study. No financial conflicts of interest were reported.