Only about one fifth of skin lesions referred to dermatologists by primary-care and other providers were found to be cancerous in a recent study — but in many cases, the specialists noticed other lesions that did turn out to be malignant.

“Almost half of all skin cancers identified were not the referred lesion,” noted Kate V. Viola, MD, of the Robert Wood Johnson Clinical Scholars Program and Yale University School of Medicine, and co-investigators. “Of great concern, 9.8% of the incidental lesions discovered by the dermatologist were melanomas”—results that show the significance of performing a total body skin examination.

The researchers analyzed the medical records of 400 patients, nearly all white men, referred to the dermatology service at the Veterans Affairs Connecticut Health System for evaluation of suspicious skin lesions from 2006 through 2009. Primary-care physicians made most of the referrals. The lesions prompting referral (index lesions) were usually located on the face (35%), the scalp/neck (12%) or a lower limb (12%).

More than half of the index lesions were considered by the consulting dermatologist to be nonmalignant by clinical assessment, requiring no biopsy. Of the 176 biopsied index lesions, 88 were malignant according to the dermatopathology report, meaning that 22% of the total group of 400 patients had an index lesion that was positive for cancer.


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However, the dermatologists also biopsied 111 incidental lesions (lesions that were not the reason for referral), 61 (55%) of which were found to be malignant. In 12 of those 61 patients, the index lesion had not required biopsy.

“Nondermatologists may benefit from the focused educational initiatives on skin cancer detection, particularly the significance of the [total body skin examination],” concluded the investigators.

In related skin cancer news, the FDA recently issued new regulations for the testing and labeling of sunscreens to help consumers choose products that offer the best protection against skin damage caused by excessive sun exposure. The final rule, which takes effect in June 2012, establishes a standard test for OTC sunscreen products that will determine which can be labeled “broad-spectrum,” meaning they provide protection against both UVA and UVB radiation.

Viola KV et al. Arch Dermatol. 2011;147:556-560