title: Total body skin examination for skin cancer screening in patients with focused symptoms.
abstract: BACKGROUND
  The value of total body skin examination (TBSE) for skin cancer screening is controversial.
  
  
  OBJECTIVE
  We sought to determine whether TBSE could be helpful in patients with focused skin symptoms who would not otherwise have undergone TBSE.
  
  
  METHODS
  In a prospective, multicenter, cross-sectional study consecutive adult patients were recruited during a period of 18 months. Physicians first inspected problem areas and uncovered areas and then performed TBSE. Equivocal lesions detected in both steps were excised or biopsied. Primary outcomes were the absolute and relative risks of missing skin cancer and the number of patients needed to examine to detect melanoma or another malignancy. A secondary outcome was the proportion of false-positive results obtained by TBSE.
  
  
  RESULTS
  We examined 14,381 patients and detected 40 (0.3%) patients with melanoma and 299 (2.1%) with at least one nonmelanoma skin cancer by TBSE. In 195 (1.3%) patients equivocal lesions found by TBSE turned out to be benign. We calculated that 47 patients need to be examined by TBSE to find one skin malignancy and 400 patients to detect one melanoma. The risk of missing one malignancy if not performing TBSE was 2.17% (95% confidence interval 1.25-3.74). Factors significantly increasing the chance to find a skin cancer were age, male gender, previous nonmelanoma skin cancer, fair skin type, skin tumor as the reason for consultation, and presence of an equivocal lesion on problem/uncovered areas.
  
  
  CONCLUSIONS
  The impact of TBSE on skin cancer mortality was not evaluated.
  
  
  CONCLUSIONS
  TBSE improves skin cancer detection in patients with focused skin symptoms and shows a low rate of false-positive results.
authors.affiliation: Department of Dermatology, Second University of Naples, Naples, Italy. g.argenziano@gmail.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.forename: Rainer
authors.initials: R
authors.lastname: Hofmann-Wellenhof
authors.forename: Renato Marchiori
authors.initials: RM
authors.lastname: Bakos
authors.forename: Wilma
authors.initials: W
authors.lastname: Bergman
authors.forename: Andreas
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authors.lastname: Blum
authors.forename: Paolo
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authors.lastname: Broganelli
authors.forename: Horacio
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authors.forename: Filomena
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authors.lastname: Caltagirone
authors.forename: Caterina
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authors.lastname: Catricalà
authors.forename: Maurizio
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authors.lastname: Coppini
authors.forename: Lucas
authors.initials: L
authors.lastname: Dewes
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Francia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Garrone
authors.forename: Bengu Gerceker
authors.initials: BG
authors.lastname: Turk
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ghigliotti
authors.forename: Jason
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authors.lastname: Giacomel
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Gourhant
authors.forename: Gerald
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authors.lastname: Hlavin
authors.forename: Nicole
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authors.lastname: Kukutsch
authors.forename: Dario
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authors.lastname: Lipari
authors.forename: Gennaro
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authors.lastname: Melchionda
authors.forename: Fezal
authors.initials: F
authors.lastname: Ozdemir
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pellicano
authors.forename: Susana
authors.initials: S
authors.lastname: Puig
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Scalvenzi
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Sortino-Rachou
authors.forename: Anna Rosa
authors.initials: AR
authors.lastname: Virgili
authors.forename: Harald
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authors.lastname: Kittler
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003430:Cross-Sectional Studies; D046169:Dermoscopy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D012871:Skin Diseases / Q000175:diagnosis; D012878:Skin Neoplasms / Q000175:diagnosis*