Clinical outcomes from skin screening clinics within a community-based melanoma screening program

J Am Acad Dermatol. 2006 Jan;54(1):105-14. doi: 10.1016/j.jaad.2005.08.072. Epub 2005 Nov 28.


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% > or = 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 > or = 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 x 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.

Publication types

  • Evaluation Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Squamous Cell / pathology
  • Community Health Services*
  • Female
  • Humans
  • Male
  • Mass Screening* / methods
  • Mass Screening* / standards
  • Melanoma / pathology
  • Middle Aged
  • Referral and Consultation
  • Sensitivity and Specificity
  • Skin / pathology
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / pathology
  • Skin Neoplasms / prevention & control*