Optimal Format for Conducting a Total Body Skin Exam

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Researchers formulated an optimal standardized total body skin examinations taking into account efficiency, missed body parts, and movements.

The results of a new study published in the Journal of the American Academy of Dermatology found that a standardized total body skin examination (TBSE) can increase accuracy and efficiency when examining the skin of all the body areas. TBSE is a standard clinical procedure, however, there is limited research on the best practices to perform it during a dermatological clinical exam.

In this research, the investigators completed an observational cohort study by video recording 5 dermatology faculty members and 5 residents conducting a regular TBSE on both a male and female standardized participant. They analyzed the exam time, physician movements, patient movements, sequence of body parts examined, and body parts missed using an analytic hierarchy process (AHP) matrix. This AHP matrix was scored by ranking efficiency, accuracy, process, and provider and patients’ movements. A t-test of unequal variance evaluated the differences in specifications.

After analyzing the data, the investigators formulated an optimal format for conducting TBSE taking into consideration efficiency, missed body parts, and movements. The proposed TBSE process begins with the patient sitting while the dermatologist examines the skin of the anterior face, scalp, neck, chest, flank, stomach, arms, hands, legs, and feet. Then, the patient stands and turns away from the examiner to have the skin of the posterior scalp, neck, back, and posterior arms and legs examined.

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The investigators recognized some limitations in this study, such as the lack of participants with physical or mental disabilities. There was a lack of hypothesis when developing the examination strategy; the investigators assumed that engineers observing physicians performing the TBSE would identify the most optimal TBSE technique. Moreover, the sample size of participants was relatively small.

The investigators concluded that “a standardized TBSE that has the capacity to increase accuracy and efficiency in examining all body parts” and suggested that further studies should assess “different relative positions between patient and examiner, ergonomic impacts, and approaches to patients with different disabilities.”

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Helm MF, Hallock KK, Bisbee E, Miller JJ. Optimizing the total body skin exam: an observational cohort study [published online February 15, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.02.028