Who is Getting a Skin Cancer Screening?

Based on data from National Health Interview Surveys, the rate of total body skin exams (TBSE) remains low in the United States, according to an oral abstract presentation given at the 2022 American Society for Dermatologic Surgery Annual Meeting.

Fazeh T. Liasi, MD; and Jonathan Ungar, MD, from the Department of Dermatology at Icahn School of Medicine at Mount Sinai, presented on the demographics of patients who seek skin cancer screenings vs TBSE.

According to data from the National Health Interview Surveys, in 2000, 7.6% of the survey population (roughly 30,000 people) reported undergoing a TBSE within the past year. However, that rate rose in 2010 to 10.6%.

Additionally, of all ethnic groups, women were more likely to report having a recent TBSE than men and the rate of TBSE increased proportionally with age.

However, Liasi said there are some current gaps in the data, including:

• A lack of direct measurement of who is coming in for TBSE,
• the US data to date does not identify TBSEs conducted by a dermatologist vs other providers,
• there is no demographic data past 2010,
• and this is no data on age or differences between sexes recorded at the initial encounter for TBSEs.

So why is demographics so important when it comes to TBSEs? In their presentation, Liasi and Ungar said that before 50 years old, rates of melanoma are higher in women than men. Moreover, after age 50, men have higher rates of melanoma and White populations have higher rates vs other races.

“Our hypothesis was that age, gender, racial, and behavioral differences in seeking TBSEs, and we still have to quantify this from direct emergency medical record (EMR) data,” said Liasi.

In the study, investigators sought to quantify the age at initial encounter for males vs females for TBSEs.

“Old studies have shown an increasing likelihood of TBSEs with age. However, in recent years we have noted an increasing number of younger patients coming for TBSEs. Many with personal or family history of skin cancer. We aim to quantify the change in demographics,” said Liasi.

A retrospective review was conducted of Epic electronic medical records (EMR) at Mount Sinai between 2011 and 2021. Records were pulled from this EMR data available at 56 outpatient sites at Mount Sinai Hospital within this 10-year period. Then, TBSE visits were identified using billing codes (99203, 99204 for initial visits and 99213, 99214 for established visits) and ICD-10 codes (D22.0-22.9,Z85,828, Z85,820, C43.0-C43.9).

After eliminating duplicates, over 90,000 unique encounters and nearly 50,000 patients between the ages of 9 to 105 years old were identified. Data on race, gender, sit of encounter, CPT and billing codes, type of encounter (initial for established), and personal history of skin cancer was collected.

Study results demonstrated that most of the patients visiting for a TBSE were White (66%).

Additionally, the average age at encounter (all types) for women was 52.9 years and for initial visits, the average age at encounter for females was 44.6 years. For men, the average age at encounter (all types) was 55.9 years and the average age at initial encounter for men was 45.9 years.

The presenters concluded by saying that based on the data from this study, “ women are coming in at a younger average age for TBSE, and both men and women are coming in for an initial visit at a younger age.”

Reference:

Liasi FT, Ungar J. Demographics of patients seeking skin cancer screening and total body skin exams: a retrospective single-center study. Presented at: 2022 American Society for Dermatologic Surgery Annual Meeting, October 7-10, Denver Colorado.