Clinical outcomes from skin screening clinics within a community-based melanoma screening program
Aitken, Joanne, Elwood, Mark, Janda, Monika, Lowe, John, Ring, Ian T., & Youl, Philippa (2006) Clinical outcomes from skin screening clinics within a community-based melanoma screening program. Journal of the American Academy of Dermatology, 54(1), pp. 105-114.
Background: Within a randomized trial of population screening for melanoma, primary care physicians conducted whole-body skin examinations and referred all patients with suspect lesions to their own doctor for further treatment.
Objective: Our aim was to describe characteristics of skin screening participants, clinical screening diagnoses, management following referral, and specificity and yield of screening examinations.
Methods: Information collected from consent forms, referral forms, and histopathological reports of lesions that had been excised or undergone biopsy was analyzed by means of descriptive statistics.
Results: A total of 16,383 whole-body skin examinations resulted in 2302 referrals (14.1% overall; 15.5% men, 18.2% $50 years of age) for 4129 suspect lesions (including 222 suspected melanoma, 1101 suspected basal cell carcinomas [BCCs], 265 suspected squamous cell carcinomas [SCCs]). Histopathologic results were available for 94.8% of 1417 lesions excised and confirmed 33 melanomas (23 in men; 24 in participants $50 years of age), 259 BCCs, and 97 SCCs. The probability of detecting skin cancer of any type within the program was 2.4%. The estimated specificity of whole-body skin examinations for melanoma was 86.1% (95% confidence interval = 85.6-86.6). The positive predictive value (number of confirmed/number of lesions excised or biopsied 3 100) for melanoma was 2.5%, 19.3% for BCC, and 7.2% for SCC overall positive predictive value for skin cancer, 28.9%).
Limitations: Follow-up of participants with a negative screening examination has not been conducted for the present investigation.
Conclusions: The rate of skin cancer detected per 100 patients screened was higher than previously reported and men and attendees older than 50 years more frequently received a referral and diagnosis of melanoma. The specificity for detection of melanoma through whole-body skin examination by a primary care physician was comparable to that of other screening tests, including mammography. (J Am Acad Dermatol 2006;54:105-14.)
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