Skin Cancer Detection Rates in Total Body Skin Examinations during First Half Versus Second Half of Shift; a Retrospective Review

Abstract

Research Question: In licensed Dermatologists, what is the effect of hours worked prior to examination on Skin Cancer Detection Rate (CDR) during Total Body Skin Examinations (TBSEs), when measured as 1st vs 2nd half of work shift?

Background, Significance, and Rationale for the Question: A pivotal study in the field of gastroenterology suggested that higher rates of colon cancer are detected during colonoscopy when the procedure is performed in the morning vs the afternoon. It was theorized that this difference is due to progressive fatigue among the practicing physicians. The primary focus of my research will be to see if this same principle holds true in the field of dermatology in regard to skin exams and skin cancer detection.

Materials and Methods: Under the direction of my primary SPT mentor Dr. Catherine Harrell, 3,407 medical charts were reviewed for skin exam findings. Cases included all TBSEs and Above Waist exams but did not include “spot” checks or otherwise limited exams, as well as excluding exams performed on minors or other vulnerable populations. Data was collected on the total number of skin checks performed by each physician, the number of hours worked by the physician prior to the exam, and the number and description of biopsy-confirmed skin cancers found by these exams. Using a combination of descriptive statistics, Student’s T-tests, Pearson’s Chi-square tests, the data was analyzed for significant differences between exams performed in the 1st vs 2nd half of shift, including differences in demographics, cancer pathology, and cancer detection rate (CDR).

Results: 3,709 charts were reviewed, of which 1,718 were included in data analysis, of which 183 had positive skin cancer findings. When split into 1st vs 2nd half of shift, no significant difference was found in subject demographics, cancer descriptors, or CDR (p=0.157). However, a breakdown of 1st and 2nd half of shift by physician suggested variability between physicians, and a potential correlation between CDR and hours worked was subjectively seen, warranting further data collection and analysis.

Conclusions: We anticipated that first-half-of-shift skin exams would demonstrate higher rates of skin cancer detection when compared to second-half-of-shift appointments. Although this is only a preliminary analysis based on incomplete data collection, initial data suggests no difference in skin exam CDR between the first half of the physician’s working day when compared to the second half, with the contradictory suggestion that one of the physicians may have an improved CDR in their 2nd half of shift. In addition, a visual trend emerged correlating CDR with number of procedures performed in that 1-hour time bucket, although statistical confirmation is pending access to advanced statistical software. While still preliminary, if these trends remain after final analysis, these results could suggest value in dermatologists analyzing their personal CDR trends for future practice structuring.