Outcomes of dermatologist-performed skin cancer screening in an academic setting: a retrospective cohort study.

Abstract

Early detection of skin cancer improves outcomes, but the utility of dermatologist-performed total body skin examinations(TBSEs) in unselected populations remains uncertain. To evaluate the diagnostic yield, biopsy burden, and temporal trends of dermatologist-led TBSEs in an academic screening program. This retrospective cohort included 3,127 encounters from 1,572 University of Miami employees and spouses who underwent annual TBSEs between January 2019-June 2024. Primary outcomes were detection of premalignant(actinic keratoses) and malignant lesions (basal cell carcinoma[BCC], squamous cell carcinoma[SCC], melanoma). Secondary outcomes included number needed to biopsy(NNB), predictive value of patient-reported lesions, and changes across screening rounds. Across TBSEs, premalignant, in-situ, and malignant lesions were detected in 11.0%, 0.22%, and 2.6% of exams. Of the screenings with malignant findings, 69 found BCC while 12 found SCC. Detection was highest among older adults and those with prior nonmelanoma skin cancer. Patient-reported "spots of concern" had low predictive value (PPV 2.7% for premalignant, 0.5% for in-situ, 1.2% for malignant). Overall NNB was 4.83, improving from 6.10 to 2.79 across rounds. Participation was voluntary, introducing selection bias; biopsy practices varied, and external procedures may have been missed. Dermatologist-performed TBSEs identified early-stage skin cancers, with higher yield in higher-risk groups.