Screening for Melanoma and Skin Cancer

Abstract

While we do disagree with certain of his interpretations and conclusions, we deeply appreciate his recognition of the impact of health fairs on the American health care system. Dr Berwick's article must be read with a firm understanding of the role of our health fairs in that system. Health fairs are viewed by NHSCVO as vehicles for health education and promotion, not as diagnostic centers or substitutes for examination by a physician. In this context, the emphasis in critiquing the value of health fairs should be placed not on the five participants in every 1,000 (Dr Berwick's numbers) who will have positive results in a screening test for hyperlipidemia, but on the 995 healthy participants who came for screening studies but left with a deep¬ er appreciation of their body, its needs, and their responsibility for its well-being. It is through education and motivation that a health fair accomplishes its goal, using screening tests merely as one of many tools. This is not to say that the manner in which the screening, consultation, and follow-up are structured is imma¬ terial. Dr Berwick and NHSCVO are in agreement that all screenings in all settings should be evaluated on the basis of several factors, including usefulness, accuracy, psychological effects on the participants, educa-tional value, direct and indirect cost, and public demand. We will continue the process of examining our educa¬ tional programs and screenings, and remain open to feedback and con¬ structive criticisms, such as those offered by Dr Berwick.

Melanoma detection rate and concordance between self-skin examination and clinical evaluation in patients attending a pigmented lesion clinic in Italy

“…This value is slightly lower than those recorded in British PLCs (from 1 : 22 to 1 : 57), 2 but we note that it is better than that of the large walk‐in screening clinics in the United States, showing a detection rate of one melanoma in 250 examinations 4 . This is probably due to the filtering process by the GPs who refer patients for dermatological consultation.…”

“…Pigmented lesion clinics (PLCs) are a permanent structure for the rapid referral of subjects with suspicious pigmented lesions in populations periodically informed about the need for the self‐detection of suspicious moles; they do not appear to be a waste of resources 2 and they represent a prompt response to an individual's concern about melanoma 3 . In the United States prevention programmes are based on open access, large, walk‐in screening clinics, 4 but in European countries prevention campaigns for melanoma are usually based on a collaboration between dermatologists and general practitioners (GP). The latter are asked to play a filtering role with the aim of improving the selection of subjects to be examined by a specially trained PLC clinician 3,5 , 6 …”

Store-and-Forward Teledermatology in Skin Cancer Triage

“…20,21 However, to our knowledge, no previous studies provide information about the nonmelanoma skin cancer pick-up rate. In that respect, after the TD-based triage, 1 of 3.7 patients seen at the clinic presented with any type of premalignant or already malignant lesion that warranted intervention.…”

Pigmented lesion clinics - are they a waste of resources?

“…These figures compare favourably with those of large walk-in screening clinics in America, which have a detection rate for melanoma of only approximately 1:250. 53 The number of biopsies undertaken per clinic may serve as a very crude measure of both workload and diagnostic accuracy of dermatologists in their ability to detect melanoma. The rates of biopsy of clinically suspicious lesions has been shown to vary from 20 to 34%.…”