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Br J Dermatol. 2019 Dec 22. doi: 10.1111/bjd.18816. [Epub ahead of print]

Modeling the Value of Risk Stratified Skin Cancer Screening of Asymptomatic Patients by Dermatologists.

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Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Harvard Combined Dermatology Residency Training Program, Boston, MA.
Department of Public Health Sciences, Loyola University Stritch School of Medicine, Chicago, IL.



Total body skin examination (TBSE) by dermatologists detects incidental skin cancers, but there is insufficient evidence for screening guidelines. As a result, dermatologists' decisions to perform screening TBSE in patients presenting for a focused visit are left to their discretion.


To model the financial and time tradeoffs of risk-stratified skin cancer screening in patients presenting with unrelated focused complaints by dermatologists.


An economic evaluation incorporating data from a previously published prospective multicenter international study as well as U.S. demographic data on age and SPT.


The mean number needed to examine (NNE) for all U.S. adults was 105 at an additional cost of $3,796 per skin cancer detected when performing TBSE on a patient who presents for a focused exam. The NNE consistently decreased with increasing age and lighter SPT for every age and SPT screening threshold. The cost per person screened increased with higher age and lighter SPT due to the higher likelihood of incurring diagnostic biopsies. The additional face-to-face time required per skin cancer detected by performing TBSE in patients who present for a focused visit was 4.5 hours for all adults.


We used a diverse cohort of international patients that did not include Americans. Due to a low event rate, we combined detection of melanoma and NMSC.


Incidental skin cancers are detected by screening TBSE and its value can be enhanced through consideration of patients' age and SPT, which are established and readily identifiable skin cancer risk factors.


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