14 DAY TRIAL // Medical care providers say that time, patient embarrassment and other illnesses represent serious barriers to patients performing skin cancer exams.
Dermatologists, internists and family practitioners are unable to carry out full-body skin examinations because of the limits the patients impose, for lack of information or trust, or simply because they do not expect to undress.
The good news however, is that dermatologists have a bit more chances of conducting such screenings, than internists and family practitioners do.
Susan A. Oliveria, Sc.D., M.P.H., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues, carried out a survey in 2005, including 2,999 physicians randomly selected from the American Medical Association's Medical Marketing Services database.
Of those who returned surveys – 1,669 (59.2 %), 559 were family practitioners, 431 were internists and 679 were dermatologists.
The results showed that more dermatologists (81.3 %) than family practitioners (59.6 %) or internists (56.4 %) report regularly performing full-body skin examinations on their patients.
The authors managed to identify the top three barriers to performing these examinations – time constraints, competing illnesses and patient embarrassment or reluctance.
Time constraints were reported to be moderate or major barriers by more family practitioners (54.4 %) and internists (54.5 %) than dermatologists (30.6 %), who were more likely to cite patient embarrassment or reluctance as a moderate or major barrier (44.2 %).
The authors hypothesized that this could be due to patients visiting the dermatologist with more stigmatizing skin conditions, to not having an established relationship with the specialist or to not expecting to undress.
They write that “patients may see a dermatologist for an isolated skin condition, such as a wart, and the dermatologist may feel awkward asking this person to undress for a full-body skin examination.
“Conversely, internists and primary care providers routinely ask patients to undress for physical examinations (such as pelvic and rectal examinations); thus, undressing for the examination is understood and expected by the patient.”
Background information in the article says that skin cancer is the most frequently diagnosed cancer in the United States, so the authors say that “it is critical for patients to adhere to primary prevention behaviors and for clinicians to adopt secondary prevention strategies aimed at early detection of skin cancer to reduce its associated morbidity and mortality.
“Previous studies have suggested that many individuals, particularly those with established risk factors for melanoma, would benefit from active skin cancer screening and surveillance, and screening by dermatologists in particular may also be cost-effective.”
Identifying the reasons that prevent people from undergoing full-body skin exams, could help to overcome them in primary as well as in secondary care settings.
“Skin cancer is an ideal cancer for encouraging screening because many risk factors are well known, including family history, the presence of atypical nevi, skin type and history and pattern of sun exposure; because the disease is highly prevalent; and because there are opportunities for early detection.
“Understanding the determinants of patient skin cancer screening could help promote interventions based on physician characteristics that are amenable to change, potentially improve physicians' prevention practices and help promote early detection.”
The report is published in the January issue of Archives of Dermatology, one of the JAMA/Archives journals.