Frequency of excisions and yields of malignant skin tumors in a population-based screening intervention of 360,288 whole-body examinations

Arch Dermatol. 2012 Aug;148(8):903-10. doi: 10.1001/archdermatol.2012.893.


Objective: To explore the frequency of excisions and yields of histopathologically confirmed skin cancer.

Design: A population-based skin cancer screening intervention (the SCREEN project) in the German state of Schleswig-Holstein (July 1, 2003, to June 30, 2004).

Setting: Physician offices. Participants could choose between nondermatologist physicians and dermatologists for their initial whole-body skin examination. All screening physicians received a mandatory 8-hour training course. PARTICIPANTS Inhabitants of Schleswig-Holstein 20 years or older with statutory health insurance (N = 360,288).

Main outcome measures: Frequency of excisions and yields of malignant skin tumors (malignant melanomas [MMs], basal cell carcinomas [BCCs], and squamous cell carcinomas [SCCs]), stratified by sex and age.

Results: Overall, 15,983 excisions were performed (1 of 23 screenees). A total of 3103 malignant skin tumors were diagnosed in 2911 persons: 585 MMs, 1961 BCCs, 392 SCCs, and 165 other malignant skin tumors. Overall, 116 persons (3103 of 360,288) had to be screened to find 1 malignant tumor, with 1 of 620 for MM, 1 of 184 for BCC, and 1 of 920 for SCC. Twenty excisions were performed to find 1 melanoma in men 65 years and older, but more than 50 excisions were required to find 1 melanoma in men aged between 20 and 49 years.

Conclusions: The results of SCREEN suggest a high yield of malignant skin tumors in a large-scale population-based screening project. We found that a high number of excisions was performed in the youngest screenees with an associated low yield, suggesting a need in screener training to emphasize a more conservative attitude toward excisions in young screenees.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Basal Cell / diagnosis
  • Carcinoma, Basal Cell / epidemiology
  • Carcinoma, Basal Cell / surgery*
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / surgery*
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Melanoma / diagnosis
  • Melanoma / epidemiology
  • Melanoma / surgery*
  • Middle Aged
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / epidemiology*
  • Skin Neoplasms / surgery*
  • Young Adult