title: Incidental lesions found in veterans referred to dermatology: the value of a dermatologic examination.
abstract: BACKGROUND
  Few studies have evaluated the detection of incidental skin cancers.
  
  
  OBJECTIVE
  We sought to evaluate the rate of incidental cutaneous malignancies in routine dermatology consults.
  
  
  METHODS
  This was a retrospective chart review of all dermatology consults at the Minneapolis Department of Veterans Affairs Medical Center over 8.25 years. Inclusion criteria included an in-person clinic visit within 18 months of the initial consult date. Patients with an in-person skin examination by a dermatologist in the 18 months before consult date were excluded.
  
  
  RESULTS
  Of 28,405 consults sent during the study period, 17,174 met inclusion criteria. In all, 2257 (13.1%) patients had 1 or more biopsied incidental lesions. Half (50.3%; n = 1674) of the 3328 biopsied incidental lesions were malignant, which included 1187 patients. The per-person detection rate for an incidental malignant lesion was 6.9% (1187/17,174). There were 87 incidental melanomas identified in 84 patients. The per-person detection rate for an incidental melanoma was 0.5% (84/17,174). The most frequent anatomical location for biopsied incidental malignancies was the head and neck (53.9%). Incidental melanomas were most frequently located on the back (33.3%).
  
  
  CONCLUSIONS
  Nondiverse patient population and conservative detection rate estimates are limitations.
  
  
  CONCLUSIONS
  An in-person skin examination by a trained dermatologist is important for detection of skin malignancies. This may have implications for teledermatology.
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Kingsley-Loso
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Grey
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Hanson
authors.affiliation: Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Srihari I
authors.initials: SI
authors.lastname: Raju
authors.affiliation: Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Parks
authors.affiliation: University of Minnesota Medical School Department of Dermatology, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Bershow
authors.affiliation: University of Minnesota Medical School Department of Dermatology, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota. Electronic address: erin.warshaw@va.gov.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001415:Back; D001706:Biopsy; D003880:Dermatology / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D033162:Incidental Findings; D007642:Keratosis / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010808:Physical Examination; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012871:Skin Diseases / Q000175:diagnosis / Q000453:epidemiology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D014728:Veterans; D058014:Veterans Health
keywords: dermatology consults; melanoma; nonmelanoma skin cancer; skin cancer; teledermatology