CHICAGO — A 30-year-old married man walked into a Pennsylvania dermatology clinic to have a round, bumpy rash of his arm examined.
The rash proved to be nothing. Typically, the doctor would have looked at it, perhaps prescribed a topical medication, and sent the man home.
But, as part of an ongoing experiment, the man agreed to undergo a dermatological exam of his entire body. The idea was to study whether this sort of screening would uncover enough unsuspected medical problems to make the procedure worthwhile.
The doctor discovered a small purple blotch on the man's left thigh. It was Kaposi's sarcoma, a type of cancer often associated with acquired immune deficiency syndrome.
"At first the man did not admit to having any risk factors for AIDS, but upon further questioning it was clear he had," said Dr. Donald P. Lookingbill, of the Pennsylvania State University College of Medicine in Hershey, Pa. "But he could have gone a long time before he became sick enough to seek treatment."
This man's case is a dramatic example of the importance of full-body exams, but as Lookingbill wrote in a recent Journal of the American Academy of Dermatology, it is not the only one.
Want to Prove Worth
"It is generally taught in medical school that it is worthwhile to do this exam, and that's what's generally believed in the profession, but I'm not sure it's that commonly done," Lookingbill said. "We wanted to prove that it's worthwhile."
Lookingbill and his colleagues performed whole-body exams on 1,106 consecutive volunteers at a dermatology clinic and found 162 important skin lesions, leading to diagnoses of previously unsuspected skin cancer, rashes and foot fungus in addition to the one AIDS case.
Older patients were far more likely to have unusual lesions, with about one-fifth of those aged 60 or over having some sort of incidental rash.
Furthermore, 13 out of 147 older patients were diagnosed with malignant basal cell carcinoma, a common, treatable form of skin cancer caused by overexposure to the sun. President Reagan has twice had basal cell tumors removed from his nose.