Yin Li, PhDRobert A. Swerlick, MD
Abstract
Importance Periodic comprehensive skin examinations of asymptomatic individuals are widely accepted by dermatologists and the public, resulting in deployment of skin cancer (SC) surveillance practices that may include patients at low risk for SC.
Objective To define the demographics, SC risk factors, and near-term outcomes of asymptomatic individuals seeking comprehensive skin examinations.
Design, Setting, and Participants This cross-sectional study is a secondary analysis of data collected through a routine, previsit survey completed by patients who visited the Emory Healthcare Dermatology Clinic between March 2021 and October 2022. This study involved new patients who had no specific skin complaints and requested a general skin examination because they had general concerns about SC. Data were analyzed between from July to December 2025.
Main Outcomes and Measures The main objective was to identify patients at higher risk for SC development by evaluating characteristics including demographics and SC risk factors including skin phototype, eye and hair color, and family and personal history of SC. The number needed to examine to diagnose 1 SC was calculated for the entire cohort and for subgroups.
Results A total of 1074 new patients who noted no skin complaints but sought examinations for concerns about SC were identified (mean [SD] age, 50.3 [15.9] years; 643 [59.9%] female). Of these patients, 186 reported a personal history of SC, with the percentage reporting a history of SC increasing with age. Among those reporting SC history, 184 (99.5%) had skin phototypes I through III. Overall, 131 patients (12.2%) underwent 146 skin biopsies, and 38 SCs were diagnosed. Three patients younger than 50 years were diagnosed with SC, and 37 of 38 SCs were diagnosed in patients with skin types I through III. The number needed to be examined to diagnose 1 SC was 181 in patients 50 years or younger and 7 in patients 70 years or older. The number needed to examine for patients with and without a history of SC was 12 and 52, respectively.
Conclusions and Relevance This study found that populations of new patients without specific skin complaints seeking care for SC surveillance may contain substantial percentages of people at low risk for diagnosis of SC. Implementation of simple triage criteria for asymptomatic patients seeking SC surveillance based on age, skin phototype, and SC history could select for patients at substantially higher risk for SC diagnosis.
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