Downstream consequences of melanoma screening in a community practice setting: First results

Abstract

BACKGROUND Population-based screening for the early detection of melanoma holds great promise for reducing melanoma mortality, but evidence is needed to determine whether benefits outweigh risks. Skin surgeries and dermatology visits after screening were assessed to indicate potential physical, psychological, and financial consequences. METHODS Targeted primary care providers (PCPs) at the University of Pittsburgh Medical Center were trained to detect early melanoma using the INFORMED (INternet course FOR Melanoma Early Detection) program. The authors analyzed aggregated administrative data describing 3 groups of patients aged ≥35 years who had received an annual physical examination by PCPs: group A1 included patients of PCPs from the group with the highest percentage of INFORMED-trained providers, group A2 included patients of PCPs from the group with a lower percentage of INFORMED-trained providers, and group B included patients of PCPs without INFORMED training. RESULTS INFORMED-trained PCPs screened 1572 of 16,472 patients in groups A1 or A2 and none of the 56,261 patients in group B. In group A1, there was a 79% increase (95% confidence interval, 15%–138%) in melanoma diagnoses noted; no increase was observed for the other groups, and no substantial increase in skin surgeries or dermatology visits occurred in any group. CONCLUSIONS A large-scale melanoma screening using the INFORMED program was conducted in Pennsylvania. To the best of the authors’ knowledge, the current study is the first analysis of downstream results and the findings indicate increased melanoma diagnoses but little impact on skin surgeries or dermatology visits. This result provides some reassurance that such efforts can be conducted without major adverse consequences, at least as measured by these parameters, and therefore should be considered for more widespread use.

Clinical Presentation and Staging of Melanoma

“…Despite the recommendations issued by the USPSTF, evidence does exist which supports the concept of widespread screening to facilitate early melanoma detection and decreased mortality (11). One of the most cited study examining the feasibility and efficacy of a population-based melanoma screening program is the SCREEN project in Northern Germany.…”

Rare nodular malignant melanoma of the heel in the Caribbean: A case report

“…The lesions of the majority of patients with cutaneous melanoma were initially detected by the patient themselves on self-examination (44%) or by their spouse (18.6%) with primary care provider (PCP) detection accounting for 25% [14], [15]. It is therefore important to emphasize public awareness and PCP awareness of the “ABCD Rule” to ensure earlier detection of cutaneous melanomas [3], [15], [16]. While screening programs have utility, they can be an economic burden in developing countries with low melanoma incidence.…”

Lack of harms from community‐based melanoma screening by primary care providers

“…As proposed in the study by Weinstock et al, PCPs are the key individuals to target for effective skin cancer early diagnosis training programs.…”

“…To our knowledge, the quality initiative conducted at the University of Pittsburgh Medical Center (UPMC) by Weinstock et al represents the first large‐scale study in the United States to attempt to address this important criticism. The overall objective of the study was to determine whether training of PCPs via the Web‐based INFORMED (INternet course FOR Melanoma Early Detection) skin cancer and triage program could reduce the risk of screening‐induced harms by correctly reassuring patients of benign skin lesions, while maintaining appropriate referral to specialists for those with a potential diagnosis of skin cancer.…”

“…When comparing the UPMC skin cancer screening effort with other screening initiatives worldwide, there are several noteworthy differences (Table ) …”