Positive correlations between most of the health care screening practices evaluated and a diagnosis of BCC or SCC were seen in age-adjusted analyses, while only modest or no associations were observed for melanoma.

Specifically, a pooled, multivariate analysis revealed that having a physical examination was associated with receiving a diagnosis of BCC (hazard ratio [HR] = 1.45; 95% confidence interval [CI], 1.33-1.58), SCC (HR = 2.05; 95% CI, 1.46-2.87), and melanoma (HR = 1.24; 95% CI, 0.80-1.92). A multivariate analysis of individuals in the Nurses’ Health Study showed a similar positive association between physical examination and diagnosis of BCC (HR = 1.46; 95% CI, 1.30-1.64), SCC (HR = 2.32; 95% CI, 1.41-3.80), and melanoma (HR = 1.66; 95% CI, 0.85-3.22). A multivariate analysis of individuals in the Health Professionals Follow-Up Study again showed a positive association between physical examination and diagnosis of BCC (HR = 1.43; 95% CI, 1.26-1.63) and SCC (HR = 1.85; 95% CI, 1.17-2.92), but not for melanoma (HR = 1.04; 95% CI, 0.64-1.69).

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Kira Minkis, MD, PhD, dermatologist at Weill Cornell Medicine and New York-Presbyterian, New York, who was not involved in the study, described the study as “interesting” during an interview with Cancer Therapy Advisor. “It kind of makes sense that, in general, somebody who is plugged into the health care system is more likely to have a diagnosis of skin cancer,” she said.

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Despite the cohorts being composed of health care professionals, Dr Minkis said the study findings should still be applicable to more general study populations.

It was unclear, however, why a melanoma diagnosis trended toward a modest or no association. Dr Minkis offered 2 possible reasons: Patients could be self-diagnosing the melanoma, which Dr Drucker and colleagues also suggested, or physicians who conduct the physical examination could be failing to diagnose the melanoma. “Certain melanomas are actually difficult to diagnose and often require specifically a dermatologist to make the diagnosis,” she explained.


  1. Drucker AM, Li WQ, Savitz DA, et al. Association between health maintenance practices and skin cancer risk as a possible source of detection bias [published online December 26, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.4216