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The Patient's Perspective

Daniel G. Federman, MD; Jeffrey D. Kravetz, MD; Daniel G. Tobin, MD; Fangchao Ma, MD, PhD; Robert S. Kirsner, MD

Arch Dermatol. 2004;140:530-534.

Objectives  To determine (1) primary care practitioner (PCP) and dermatologist full-body skin examination (FBSE) rates by using a patient questionnaire and (2) whether patient risk factors for skin cancer alter these rates.

Design  Questionnaires pertaining to whether participants underwent regular FBSE, their feelings about this screening test, and their risks for developing skin cancer.

Setting  The primary care and dermatology clinics at the West Haven Veterans Affairs Medical Center.

Participants  A convenience sample of 356 patients awaiting clinic appointments. Of those asked to participate, 251 (71%) agreed.

Main Outcome Measures  Patient report of undergoing FBSE, attitudes regarding this examination, and risk factors for cutaneous malignancy.

Results  Thirty-two percent of all respondents reported undergoing regular FBSE by their PCP, whereas 55% of those with a history of skin cancer reported undergoing FBSE. Eight percent of participants reported embarrassment with FBSE, 83% reported that their PCP would be considered thorough by performing FBSE, and 87% would like their PCP to perform FBSE regularly. Only 2% of participants would refuse the examination if the PCP were of the opposite sex, whereas 8% would be more willing to be examined.

Conclusions  Although patients report a low incidence of FBSE, those with a personal history of skin cancer are more likely to be screened. A low rate of embarrassment and a high rate of perceived PCP thoroughness are associated with FBSE. Patients have a strong preference to undergo FBSE. A sex difference between the PCP and the patient should not be a barrier to this examination.

From the Department of Medicine, Veterans Affairs Connecticut Health Care Center, West Haven (Drs Federman, Kravetz, and Tobin); Yale University School of Medicine, New Haven, Conn (Drs Federman, Kravetz, and Tobin); the Department of Dermatology, Miami Veterans Affairs Medical Center, Miami, Fla (Drs Ma and Kirsner); and the University of Miami School of Medicine (Drs Ma and Kirsner). The authors have no relevant financial interest in this article.

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