Effectiveness of interventions to support the early detection of skin cancer through skin self‐examination: a systematic review and meta‐analysis

Abstract

Summary Background As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self‐examination (SSE); however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE interventions. Objectives To systematically examine, map, appraise and synthesize, qualitatively and quantitatively, studies evaluating the early detection of skin cancer, using SSE interventions. Methods This is a systematic review (narrative synthesis and meta‐analysis) examining randomized controlled trials (RCTs) and quasiexperimental, observational and qualitative studies, published in English, using PRISMA and National Institute for Health and Care Excellence guidance. The MEDLINE, Embase and PsycINFO databases were searched through to April 2015 (updated in April 2018 using MEDLINE). Risk‐of‐bias assessment was conducted. Results Included studies (n = 18), totalling 6836 participants, were derived from 22 papers; these included 12 RCTs and five quasiexperiments and one complex‐intervention development. More studies (n = 10) focused on targeting high‐risk groups (surveillance) than those at no higher risk (screening) (n = 8). Ten (45%) study interventions were theoretically underpinned. All of the study outcomes were self‐reported, behaviour related and nonclinical in nature. Meta‐analysis demonstrated the impact of the intervention on the degree of SSE activity from five studies, especially in the short term (up to 4 months) (odds ratio 2·31, 95% confidence interval 1·90–2·82), but with small effect sizes. Risk‐of‐bias assessment indicated that 61% of the studies (n = 11) were of weak quality. Conclusions Four RCTs and a quasiexperimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer. However, the actual clinical impact remains unclear, and this is based on overall weak study (evidence) quality.

Significant limitations of a systematic review and meta‐analysis of interventions to promote skin self‐examination

“…Dear Editor, Ersser and colleagues’ review of interventions to promote skin self‐examination is timely and relevant, insofar as the topic is of considerable current clinical and research interest. However, it is subject to two significant limitations.…”

Is there a role for digital technology in measuring the value of skin self‐examination?

“…In this issue of the BJD , Ersser et al . systematically review behavioural interventions that promote skin self‐examination, highlighting future research frontiers.…”

“…Digital technology could also be used to create social support for skin checking, by linking people with a checking partner who could remind and encourage each other to conduct the desired behaviour. As Ersser and colleagues rightly argue, future interventions should creatively integrate apps and digital devices into their intervention and outcome measurement tools to increase the validity of benefit assessment. In contrast, future studies solely relying on self‐reported outcomes should be discouraged as they are unlikely to move the field forward.…”

“…In this issue of the BJD, Ersser et al 1 systematically review behavioural interventions that promote skin self-examination, highlighting future research frontiers. Fifteen intervention studies focused on improving skin self-examination behaviours, but none targeted a hard outcome such as reduction in thickness of melanoma or disease-free survival.…”

Significant limitations of a systematic review and meta‐analysis of interventions to promote skin self‐examination: reply from the authors

“…D ear E ditor , Further to Coups’ letter on our systematic review and meta‐analysis of interventions promoting skin self‐examination (SSE), of the ‘reviews’ cited, one is a systematic review and the other a scoping review . The interventional focus of Wu et al .…”