Skin cancer screening focusing on melanoma yields more selective attendance

Screening theoretically reduces death and morbidity from malignant melanoma. The rationale of screening for nonmelanoma skin cancer is more debatable, since mortality is very low.

We organized a screening campaign in Southern Limburg, the Netherlands, in 1993. Press releases and public announcements referred only to melanoma. The results were compared with similar campaigns in Arnhem and Eindhoven, the Netherlands, in 1990; these, however, addressed skin cancer in general.

There were 4146 people attending the 1993 screenings, compared with 2463 in 1990. The proportion of screenees with lesions suggestive of melanoma increased from 1.1% in 1990 to 1.7% during the 1993 campaign (P = .04). The proportion of dysplastic nevi rose from 2.1% to 7.7% (P < .001). Nonmelanoma skin cancers were less often encountered (3.7% in 1990 vs 2.6% in 1993; P = .009). Actinic keratoses were also less numerous (6.3% vs 1.5%; P < .001).

Screening concentrating on melanoma increases the rates of lesions suggestive of melanoma and dysplastic nevi, whereas the proportions of basal and squamous cell carcinomas and actinic keratoses decrease. These findings may have important implications with regard to the cost-effectiveness of skin cancer screening efforts.