Complete follow-up and evaluation of a skin cancer screening in Connecticut

On May 21, 1988, 251 persons were screened for skin cancer in New Haven, Connecticut. A total body skin examination was performed on 98% of the participants. On the basis of follow-up of 93% of persons with positive screens for basal cell carcinoma, squamous cell carcinoma, or Bowen's disease, positive predictive values were 43% for basal cell carcinoma, 14% for squamous cell carcinoma, and 50% for Bowen's disease. In the group with atypical nevi, a person with two or more clinically atypical nevi was 16 times more likely to have histologic confirmation than a person with a single clinically atypical nevus (p = 0.003). Eighty persons were screened by both a dermatologist and a dermatology nurse; the crude agreement rate for actinic keratoses was 0.62; for atypical nevi, 0.53; and for BCC, 0.88. Both nurses and physicians overdiagnosed in the screening setting, the nurses more so than the physicians. Of the 128 persons screened who were advised to seek medical follow-up, 16 did not do so despite several reminders; their reasons are discussed.