Description of the Evidence
A population-based trial using cluster randomization to determine the effect of skin screening on melanoma mortality was initiated in Queensland, Australia. Intervention communities were randomly assigned to receive a 3-year program targeting adults older than age 30 years. The program consisted of:
- Community education and promotion of self-screening.
- General practitioner education about screening and training in the diagnosis of melanoma.
- Free skin cancer screening clinics.
Matched control communities received usual care. Originally designed to include 44 matched communities followed for 15 years, the trial lost its funding after its initial pilot phase in 18 communities (population 63,035). Although the pilot phase established feasibility of community-based programs, no health outcomes were reported. In the study, 16,383 whole-body skin examinations were reported in the intervention communities, resulting in a referral rate of 14.1% (18.2% for people older than age 50 years). Thirty-three melanomas were diagnosed, 13 of which were in situ. The estimated specificity for melanoma was 86.1%, with a positive predictive value (PPV) of 2.5%. The PPVs for squamous cell and for basal cell cancers were 7.2% and 19.3%, respectively. Negative screens were not followed up, and the sensitivity of skin examination was not reported.
Evidence of Harm Associated With Screening
Harms have not been well studied or reported in quantitative terms. However, visual examination of the skin in asymptomatic individuals may lead to unavoidable adverse consequences. These include complications of diagnostic or treatment interventions (including extensive surgery) and the psychological effects of being labeled with a potentially fatal disease. Another harmful consequence is overdiagnosis leading to the detection of biologically benign disease that would otherwise go undetected, and the possibility of misdiagnosis of a benign lesion as malignant. (Refer to the Accuracy of Making a Clinical Diagnosis of Melanoma section of this summary for more information.)
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