A Large Skin Cancer Screening Quality Initiative

Abstract

IMPORTANCE The lack of prospective randomized clinical trials demonstrating that full-body skin examination (FBSE) reduces melanoma morbidity or mortality has prompted an “I” rating from the United States Preventive Services Task Force for population-based skin cancer screening. More data on these screening programs are needed. OBJECTIVES To describe a skin cancer screening quality initiative in a large health care system and to determine if the intervention was associated with screening of a demographically higher-risk population than previous screening programs and if melanoma incidence and thickness differed in screened vs unscreened patients. DESIGN, SETTING, AND PARTICIPANTS This observational evaluation of a prospectively implemented quality initiative was conducted in a large health care system in western Pennsylvania (University of Pittsburgh Medical Center, UPMC) among adults seen in an office visit by a UPMC-employed primary care physician (PCP) in 2014. INTERVENTIONS Implementation of a campaign promoting annual skin cancer screening by FBSE, including training of PCPs, promotion of the initiative to physicians and patients, and modification of the electronic health record (EHR) to include FBSE as a recommended preventive service for patients 35 years or older. MAIN OUTCOMES AND MEASURES Characteristics of screened and unscreened patients and melanomas detected among them. RESULTS Of 333 735 adult patients seen in an office visit by PCPs in 2014, 53 196 patients (15.9%of the screen-eligible population) received an FBSE, and 280 539 did not. Screened patients were slightly older (median age, 60 vs 57 years; P < .001) but did not differ significantly by sex (43.2%vs 43.1% men; P = .49) from the unscreened population. Fifty melanomas were diagnosed in screened patients and 104 melanomas were diagnosed in unscreened patients. Screened patients were more likely than unscreened patients to be diagnosed with melanoma (adjusted risk ratio [RR], 2.4; 95%CI, 1.7–3.4; P < .001) and to have a thinner invasive melanoma (median thickness, 0.37 mm vs 0.65 mm; P < .001). The incidence of melanoma lesions 1 mm or thicker was similar in screened vs unscreened patients (adjusted RR, 0.7; 95%CI, 02.–2.2; P = .52). CONCLUSIONS AND RELEVANCE Large-scale screening for melanoma within a United States health care system is feasible and can result in increased detection of thinner melanomas. This intervention also resulted in screening of a higher proportion of men and an older patient population than previous screening interventions in which younger individuals and women predominated.

A Randomized Trial on the Efficacy of Mastery Learning for Primary Care Provider Melanoma Opportunistic Screening Skills and Practice

“…32 Thus, it seems likely that performing opportunistic screening in at-risk patients will improve the detection of early melanoma without incurring the risks of unnecessary procedures or additional financial and time burdens for the patient. 14,33 The study has several limitations. Since it is not possible to ascertain the number of melanomas and atypical nevi that were not considered clinically concerning by PCPs, there is a danger of underestimating the false-negative diagnosis, which may have biased the findings.…”

Risks of Melanoma and Other Cancers in Melanoma-Prone Families over 4 Decades

“…Some are even advocating for melanoma prevention and early detection within the general population (Tripp et al, 2016). Limited data suggest that screening within a health care system is feasible, resulting in earlier detection of melanoma (Ferris et al, 2017), but more research is needed.…”

Psychosocial impact of skin biopsies in the setting of melanoma screening: a cross‐sectional survey

“…D ear E ditor , An inability to assess adequately the potential psychological consequences of skin biopsies contributed to the 2016 United States Preventive Services Task Force (USPSTF) issuing an insufficient ‘I’ rating for skin cancer screenings . To our knowledge, no published studies have investigated the potential psychosocial impact of skin biopsies after routine skin examinations for melanoma.…”

“…To determine whether skin biopsies adversely affect psychosocial well‐being, we conducted a cross‐sectional study within a skin cancer screening cohort comparing anxiety and distress among patients screened for melanoma with and without a history of skin biopsy. This study was one of multiple assessments launched by the University of Pittsburgh Medical Center (UPMC) initiative, created to better understand potential consequences of melanoma screening …”