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Screening for skin cancer.

M Helfand1, S M Mahon, K B Eden

  • 1Division of Medical Informatics and Outcomes Research, Evidence-based Practice Center, Oregon Health Sciences University, Portland, Oregon 97201-3098, USA. helfand@ohsu.edu

American Journal of Preventive Medicine
|April 18, 2001
PubMed
Summary
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Routine skin cancer screening by primary care providers lacks evidence of reduced melanoma mortality. While screening accuracy is fair, further research is needed to identify high-risk individuals for targeted skin cancer detection.

Area of Science:

  • Dermatology
  • Preventive Medicine
  • Public Health

Background:

  • Malignant melanoma incidence has rapidly increased, posing a significant mortality risk.
  • Nonmelanoma skin cancer, while seldom lethal, can cause disfigurement and morbidity if advanced.
  • Current professional society recommendations for skin cancer screening vary.

Purpose of the Study:

  • To evaluate published data on the effectiveness of routine skin cancer screening by primary care providers.
  • To inform the U.S. Preventive Services Task Force assessment on skin cancer screening.

Main Methods:

  • Conducted a systematic literature search of MEDLINE (1994-1999) and other sources for studies on skin cancer screening.
  • Included studies with data on screening yield, test accuracy (sensitivity, specificity), risk factors, and cost-effectiveness.

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  • Two independent reviewers assessed abstracts, with one reviewer handling the remainder after consistency was established.

    • Main Results:

    • No randomized or case-control studies demonstrate that routine primary care screening reduces melanoma morbidity or mortality.
    • Formal screening programs have not shown improved cure rates for basal cell and squamous cell carcinomas, which are typically curative.
    • Skin examination demonstrated high accuracy in mass screening programs (sensitivity 94%, specificity 98%); risk assessment identified a small high-risk group.

    Conclusions:

    • Evidence quality for routine primary care screening accuracy for melanoma and nonmelanoma skin cancer is poor to fair.
    • No studies assessed periodic clinician skin examinations' effectiveness in reducing melanoma mortality.
    • Risk-assessment techniques may help identify high-risk patients for targeted skin cancer screening, warranting further study.