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 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.