Screening for skin cancer in primary care settings

Objective: To estimate the frequency of recorded screening for skin cancer in primary care settings. Design: Retrospective observational cohort study. Setting: Two academically affiliated Department of Veterans Affairs Medical Centers. Subjects: Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics. Main Outcome Measure: Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period. Methods: Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits. Results: Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%); prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P<.001 for each comparison with other tests). As an estimate of the 'true' frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination. Conclusion: Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.