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Experts optimize the total-body skin exam

Researchers developed a standardized total-body skin examination procedure using video recordings of dermatology faculty members and residents conducting regular total-body skin examinations.

“We propose a standardized total-body skin examination that has the capacity to increase accuracy and time efficiency in examining all body parts,” Matthew F. Helm, MD, of the department of dermatology at Penn State Health Hershey Medical Center, and colleagues wrote. “This approach provides a uniform method for teaching the total-body skin examination to health care professionals.”

The study involved five dermatology faculty members and five residents conducting regular total-body skin examinations on both a male and female patient.

Total examination time ranged from 75 to 243 seconds.

Physician experience of faculty compared with residents did not affect examination time, but there was significant variability between providers in their efficiency and order of examination, according to researchers.

The head, legs and arms had the highest effective time per body part, which was determined as a percentage of time examining a given body part divided by the total time of the exam.

The neck had the highest frequency of being missed (29.5%) followed by the underarm region (13.6%).

Due to unnecessary movements of the physician and participant, 48.1 seconds were lost in the male patient examination and 42.3 seconds in the female patient examination.

The researchers determined that about one-third of the examination time for the male patient and one-fourth of time for the female patient were wasted on unnecessary movements.

After analyzing the examination data, the researchers formulated an optimal standardized total-body skin examination, which considered efficiency, missed body parts and movements.

In the proposed examination, the patient begins sitting while the dermatologist examines the anterior face, scalp, neck, chest, flank, stomach, arms, hands, legs and feet of the patient. Next, the patient stands up and turns away from the examiner to have the posterior scalp, neck, back, posterior arms and legs examined. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.