Total body examination versus lesion-directed screening. Which is best?

Evaluation of the two distinct approaches to dermatological examinations.
Written by
Toby Nelson
Published on
January 4, 2024

The evidence to support the role of skin screening as a means to improve skin cancer prognosis is limited. Within high-risk environments such as New Zealand or the sun belts of America it may be of some use. In populations where there is limited access to experts lesion-directed screening has been found to be an effective alternative. Total body examination (TBE) and lesion-directed screening are two distinct approaches to dermatological examinations, each serving specific purposes in skin health assessment.


TotalBody Examination (TBE): TBE involves a comprehensive and systematic evaluation of the entire skin surface. During a TBE, a healthcare professional, often a dermatologist, thoroughly examines the skin from head to toe, inspecting all areas for any abnormalities, lesions, or signs of skin conditions. This approach is proactive and is commonly used as a preventive measure to detect skin cancers, such as melanoma, at an early stage. TBE is recommended for individuals with a history of skin cancer, a high number of moles, or other risk factors.


Lesion-DirectedScreening: In contrast, lesion-directed screening is a targeted approach that focuses on a specific lesion or area of concern. This method is employed when there is a known or suspected issue with a particular skin abnormality, such asa mole exhibiting changes in size, colour, or shape. Lesion-directed screening is more reactive and is often initiated in response to patient-reported concerns or when a healthcare professional identifies a specific lesion that requires closer examination. Dermatologists use this approach to investigate and diagnose specific skin lesions efficiently.


WhileTBE aims for a comprehensive overview of the skin, lesion-directed screening isa more focused strategy that addresses individual concerns. Both approaches play essential roles in dermatological care, with TBE serving as a proactive screening tool and lesion-directed screening providing targeted assessments for identified skin abnormalities. The choice between the two methods depends on factors such as the patient's medical history, risk factors, and the nature of any specific skin concerns.


Lesion-directed screening to optimize skin cancer detection in dermatology practice: an observational study.

Eur Acad Dermatol Venereol.2021 Jun;35(6):1309-1314. doi: 10.1111/jdv.17129. Epub 2021 Feb 12.


Total-Body Examination vs Lesion-Directed Skin CancerScreening.

Hoorens I, Vossaert K, Pil L, Boone B, De Schepper S,Ongenae K, Annemans L, Chevolet I, Brochez L.

JAMA Dermatol. 2016 Jan;152(1):27-34. doi:10.1001/jamadermatol.2015.2680.

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