Abstract and Introduction
Background: The incidence of melanoma and nonmelanoma skin cancer continues to increase. To detect lesions at an earlier phase in their progression, skin cancer screening programs have been advocated by some. However, the effectiveness of skin cancer screening and the ideal population that these screenings should target have yet to be firmly established. This study details the relationship of a group of well-known risk factors with presumptive diagnoses in a large series of individuals self-referred for free skin cancer screening.
Methods: Data obtained during 2007 to 2010 from a descriptive cross-sectional study skin cancer screening program are presented. Participant history was recorded using standardized medical history forms prior to skin examination. Screeners conducted a skin examination varying from whole-body to limited areas (per participant preference) and recorded diagnoses. Diagnoses were assigned to the nonmelanoma cancer (NMC) or suspicious pigmented lesion group for analysis.
Results: A presumptive diagnosis of NMC was associated with male sex, age ≥ 50 years, personal history of skin cancer, lower skin phototype, increased sunscreen use, and increased chronic sun exposure (all P values ≤ .0001). After controlling for skin phototype, increased sunscreen use was not associated with a presumptive diagnosis of NMC (P = .96). Presumptive diagnosis of a suspicious pigmented lesion was associated with a reported history of "changing mole" (P < .0001) and negatively associated with age ≥ 50 years (P < .0001) and a personal history of skin cancer (P = .0119).
Conclusions: Several known risk factors for nonmelanoma skin cancer correlated with a presumptive diagnosis of NMC. The yield of presumptive atypical pigmented lesions was increased in participants aged < 50 years, supporting the notion that this population may benefit from screening.
In the United States, the overall incidence and mortality rate of melanoma has increased in recent decades. Cutaneous melanoma currently ranks fifth for men and seventh for women in incidence of all new cancers diagnosed, and an estimated 76,690 new cases will be diagnosed in the United States in 2013. Nonmelanoma skin cancers, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) continue to be the most commonly diagnosed cancers in the United States, and more than 3.5 million cases were diag nosed in 2006. These neoplasms significantly impact the public health burden by contributing to medical cost, morbidity, and mortality.
Prevention and early detection of skin cancer have been emphasized. Free skin cancer screenings consisting of whole-body visual skin examinations performed by cutaneous oncology specialists are advocated by both the American Academy of Dermatology (AAD) and the American Cancer Society. However, the US Preventive Services Task Force concluded that sufficient evidence does not exist to recommend for or against routine screening for skin cancer using totalbody skin examination. Concerns cited by critics of routine screening include low cost effectiveness and lack of conclusive evidence demonstrating that routine screening improves clinical outcomes by reducing morbidity and mortality. Advocates of screening have noted reductions in the frequency of thick melanomas in association with skin cancer screening programs, and results from a large-scale, systematic, skin cancer screening program in Germany reported a reduction in mortality associated with melanoma. Utilizing AAD screening data, Geller et al reported a lower frequency of melanomas thicker than 1.50 mm (2%) compared with the National Cancer Institute's Surveillance, Epidemiology, and End Results registry (10%). Aitken et al reported results from a population- based, case-control study that examined whether a whole-body clinical skin examination within the preceding 3 years was associated with a change in the thickness of subsequently diagnosed melanomas. Their results showed that a recent whole-body clinical skin examination was associated with a 14% reduction in the risk of thick melanomas (> 0.75 mm). Because of the strong relationship between melanoma thickness and mortality, they postulated that screening may decrease mortality rates from melanoma.
Targeted Screening Programs
Identifying and subsequently targeting high-risk populations with screening programs may improve the yield and cost effectiveness of screening. Several phenotypical and environmental risk factors may be associated with an increased risk of nonmelanoma skin cancer and melanoma. The risk conferred by each of these factors and the benefit of efforts, such as applying sunscreen, to prevent the development of nonmelanoma skin cancer and melanoma remain areas of inquiry.