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A Prospective, Randomized Multicenter Study

Iris Zalaudek, MD; Harald Kittler, MD; Ashfaq A. Marghoob, MD; Anna Balato, MD; Andreas Blum, MD; Stéphane Dalle, MD; Gerardo Ferrara, MD; Regina Fink-Puches, MD; Caterina M. Giorgio, MD; Rainer Hofmann-Wellenhof, MD; Josep Malvehy, MD; Elvira Moscarella, MD; Susana Puig, MD; Massimiliano Scalvenzi, MD; Luc Thomas, MD; Giuseppe Argenziano, MD

Arch Dermatol. 2008;144(4):509-513.

Objective  To determine the time required to perform a complete skin examination (CSE) as a means of opportunistic screening for skin cancer both without and with dermoscopy.

Design  Randomized, prospective multicenter study.

Setting  Eight referral pigmented lesion clinics.

Patients  From June 2006 to January 2007, 1359 patients with at least 1 melanocytic or nonmelanocytic skin lesion were randomly selected to receive a CSE without dermoscopy or CSE with dermoscopy. For each patient, the total number of lesions and the duration of the CSE were recorded. A total of 1328 patients were eligible for analysis (31 were excluded because of missing data).

Main Outcome Measures  The median time (measured in seconds) needed for CSE with and without dermoscopy and according to total cutaneous lesion count.

Results  The median time needed for CSE without dermoscopy was 70 seconds and with dermoscopy was 142 seconds, a significant difference of 72 seconds (P < .001). The use of dermoscopy increased the duration of CSE, and this increase was in direct proportion to the patient's total lesion count. In contrast, the time required to perform a CSE without dermoscopy remained the same irrespective of whether the patients had few or many lesions.

Conclusions  A CSE aided by dermoscopy takes significantly longer than a CSE without dermoscopy. However, a thorough CSE, with or without dermoscopy, requires less than 3 minutes, which is a reasonable amount of added time to potentially prevent the morbidity and mortality associated with skin cancer.

Author Affiliations: Departments of Dermatology, Medical University of Graz, Graz, Austria (Drs Zalaudek, Fink-Puches, and Hofmann-Wellenhof), Medical University of Vienna, Vienna, Austria (Dr Kittler), Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Marghoob), and University of Naples Federico II, Naples, Italy (Drs Balato and Scalvenzi); Dermatology Unit, Hôtel Dieu de Lyon, Lyon, France (Drs Dalle and Thomas); Pathologic Anatomy Service, Gaetano Rummo General Hospital, Benevento, Italy (Dr Ferrara); and Departments of Dermatology, Second University of Naples, Naples, Italy (Drs Giorgio, Moscarella, and Argenziano), and Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain (Drs Malvehy and Puig). Dr Blum is in private practice in Konstanz, Germany.