Skin-cancer screening: a three-year experience that paid for itself

The incidence of cutaneous malignant melanoma is steadily rising. Although cancer screening guidelines seek to increase the frequency of curative early excision of melanomas, it is unclear how these guidelines can be economically incorporated into clinical practice.

A free skin-cancer screening clinic, which used a brief undressed skin examination, was held annually for 3 successive years at a private, rural, family physician's office. The goal was to identify undiagnosed melanomas with the expectation of finding other skin cancers as well. Data were collected on marginal costs to the practice, confirmatory follow-up examinations, and marginal revenue received from follow-up treatment with the author.

Of 247 persons screened, 70 (28%) sought a follow-up examination with either the author (38 patients) or their primary or other consulting physicians (32 patients). Fifty-four percent of the 70 patients who followed up (15% of the total screened) were found on biopsy or repeat physical examination to have malignant or premalignant lesions, including one melanoma. The 38 participants seen in follow-up by the author generated 114 patient encounters with the billing of 151 procedures and office visits. Marginal revenues generated by the follow-up procedures and office visits with the author following this free skin-cancer screening exceeded by 3.6 times the marginal cost of the screening.

A free mass skin-cancer screening in a rural setting by a family physician can identify melanoma and other previously undiagnosed skin cancers and pay for itself as well.