Does screening by primary care providers effectively detect melanoma and other skin cancers?
EVIDENCE-BASED ANSWER:
Possibly. No trials have directly assessed detection of melanoma and other skin cancers by primary care providers.
Training a group comprised largely of primary care physicians to perform skin cancer screening was associated with a 41% increase in skin cancer diagnoses but no change in melanoma mortality.
Visual screening for melanoma by primary care physicians is 40% sensitive and 86% specific (compared with 49% and 98%, respectively, for dermatologists and plastic surgeons).
Melanomas found by visual screening are 38% more likely to be thin (≤ 0.75 mm) than melanomas discovered without screening, which correlates with improved outcomes.
Visual skin cancer screening overall is associated with false-positive rates as follows: 28 biopsies for each melanoma detected, 9 to 10 biopsies for each basal cell carcinoma, and 28 to 56 biopsies for squamous cell carcinoma. False-positive rates are higher for women—as much as double the rate for men—and younger patients—as much as 20-fold the rate for older patients (strength of recommendations for all foregoing statements: B, cohort studies).
Editor’s Takeaway
Skin cancer screening by primary care physicians is associated with increased detection of skin cancers, including melanomas—even though we have no confirmation that it changes melanoma mortality. It is unclear what the appropriate rate of false-positive screening tests should be, but wider adoption of noninvasive diagnostic techniques such as dermoscopy might reduce unwarranted biopsies.
