Optimizing the Total-Body Skin Exam: An Observational Cohort Study

J Am Acad Dermatol. 2019 Nov;81(5):1115-1119. doi: 10.1016/j.jaad.2019.02.028. Epub 2019 Feb 15.


Background: Total-body skin examinations (TBSEs) are commonly performed in clinical practice. There is limited research on best practices for performing a TBSE.

Objective: To optimize the TBSE.

Methods: We performed an observational cohort study by video recording 5 dermatology faculty and 5 residents conducting their regular TBSE on both a healthy male and female patient. Examination time, physician movements, patient movements, sequence of body parts examined, and body parts missed were analyzed by using an analytic hierarchy process matrix. Differences were evaluated by a t test of unequal variance. P values < .05 were deemed significant.

Results: We identified an optimal format for conducting a TBSE that is efficient and accurate.

Limitations: This study was conducted with only standard healthy examiners and patients, rather than individuals with a variety of physical or mental disabilities. The structure of the study was not hypothesis driven, and we assumed that the engineers observing the physicians performing the examination would identify the most optimal TBSE.

Conclusion: Our results indicate that a standardized process of performing a TBSE minimizes the chance of missing a body area. This could also have implications on teaching a standardized TBSE to medical students, residents, and physicians.

Keywords: complete skin examination; detection; screening; skin cancer; total-body skin examination.

Publication types

  • Observational Study

MeSH terms

  • Cohort Studies
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Male
  • Physical Examination* / methods
  • Physical Examination* / standards
  • Skin Neoplasms / diagnosis*