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Skin Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Description of the Evidence

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A study of skin biopsy rates in relation to melanoma incidence rates obtained from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute indicated that much of the observed increase in incidence between 1986 and 2001 was confined to local disease and was most likely caused by overdiagnosis as a result of increased skin biopsy rates during this period.[6]

Risk Factors

Epidemiologic evidence suggests that exposure to UV radiation and the sensitivity of an individual's skin to UV radiation are risk factors for skin cancer, although the type of exposure (high-intensity and short-duration vs. chronic exposure) and pattern of exposure (continuous vs. intermittent) may differ among the three main types of skin cancer.[7,8,9] In addition, the immune system may play a role in pathogenesis of skin cancers. Organ-transplant recipients receiving immunosuppressive drugs are at elevated risk of skin cancers, particularly squamous cell cancers (SCC). Arsenic exposure also increases the risk of cutaneous SCC.[10,11]

The incidence of melanoma rises rapidly in Caucasians after age 20 years. Fair-skinned individuals exposed to the sun are at higher risk. Individuals with certain types of pigmented lesions (dysplastic or atypical nevi), with several large nondysplastic nevi, with many small nevi, or with moderate freckling have a twofold to threefold increased risk of developing melanoma.[12] Individuals with familial dysplastic nevus syndrome or with several dysplastic or atypical nevi are at high (>fivefold) risk of developing melanoma.[12]

Accuracy of Making a Clinical Diagnosis of Melanoma

A systematic review of 32 studies that compared the accuracy of dermatologists and primary care physicians in making a clinical diagnosis of melanoma concluded that there was no statistically significant difference in accuracy. However, the results were inconclusive, owing to small sample sizes and study design weaknesses.[13] In addition, differentiating between benign and malignant melanocytic tumors during histologic examination of biopsy specimens has been shown to be inconsistent even in the hands of experienced dermatopathologists.[14] This fact undermines results of studies examining screening effectiveness and also may undermine the effectiveness of any screening intervention. Furthermore, this suggests that requesting a second opinion regarding the pathology of biopsy specimens may be important.[14]

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