Authors' objectives:

To examine published data on the effectiveness of screening for skin cancer by a primary care provider.

Authors' results and conclusions: No randomized or case-control studies demonstrate that screening for melanoma reduces morbidity or mortality. Basal cell carcinoma and squamous cell carcinoma are common, but detection and treatment in the absence of formal screening is almost always curative. No controlled studies have shown that formal screening programs improve this already high cure rate. Although the efficacy of screening has not been established, the screening procedures themselves are noninvasive, and the follow-up test -- skin biopsy -- has low morbidity. Estimates of accuracy of screening are based on cross-sectional studies that suffer from workup bias. One prospective study tracked patients who had negative results to determine the number of patients who had false-negative results. In this study, the sensitivity of screening for skin cancer was 0.94 and specificity was 0.975. Several recent case-control studies confirm earlier evidence that patients who have atypical moles, many (>50) common moles, or both are at increased risk for melanoma. One well-done prospective study demonstrated that risk assessment by limited physical examination identified a relatively small (<10%) group of primary care patients for more thorough evaluation.

Authors' recommendations: The quality of the evidence for routine screening by primary care providers for early detection of melanoma or nonmelanoma skin cancer ranged from poor to fair. Despite the lack of evidence, skin cancer screening, perhaps by means of a risk-assessment technique to identify high-risk patients who are seeing a physician for other reasons, is the most promising strategy for addressing the excess burden of disease in older adults.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspsskca.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)