Incidental lesions found in veterans referred to dermatology: The value of a dermatologic examination

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 Ve...

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Bibliographic Details
Published in:	Journal of the American Academy of Dermatology 2015-04, Vol.72 (4), p.651-655.e1
Main Authors:	Kingsley-Loso, Jaime L., BA, Grey, Katherine R., BA, Hanson, Jamie L., BS, Raju, Srihari I., MD, Parks, Patricia R., MA, Bershow, Andrea L., MD, Warshaw, Erin M., MD
Format:	Article
Language:	eng
Subjects:	Aged Aged, 80 and over Back Biopsy Dermatology Dermatology - methods dermatology consults Female Head and Neck Neoplasms - diagnosis Head and Neck Neoplasms - epidemiology Hospitals, Veterans - statistics & numerical data Humans Incidental Findings Keratosis - diagnosis Keratosis - epidemiology Male melanoma Melanoma - diagnosis Melanoma - epidemiology Middle Aged Minnesota - epidemiology nonmelanoma skin cancer Physical Examination Referral and Consultation Retrospective Studies Risk Factors skin cancer Skin Diseases - diagnosis Skin Diseases - epidemiology Skin Neoplasms - diagnosis Skin Neoplasms - epidemiology teledermatology Veterans Veterans Health
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Summary:	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%). Limitations Nondiverse patient population and conservative detection rate estimates are limitations. Conclusion An in-person skin examination by a trained dermatologist is important for detection of skin malignancies. This may have implications for teledermatology.
ISSN:	0190-9622 1097-6787