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

Matthews, Natalie H.; Risica, Patricia Markham; Ferris, Laura K.; Beatson, Meghan; Saul, Melissa; Geller, Alan C.; Solano, Francis X.; Kirkwood, John M.; Weinstock, Martin A.

doi:10.1111/bjd.17134

Cited by 6 publications

(8 citation statements)

References 7 publications

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“…Our initiative did not offer physician compensation specifically for screening and used existing health care infrastructure, resulting in low direct costs. Previous studies have shown that harms such as increased costs due to dermatology visits and procedures and increased patient anxiety secondary to screening or skin biopsy were not seen among patients in this screened population …”

Section: Discussionmentioning

confidence: 78%

Five-Year Outcomes of a Melanoma Screening Initiative in a Large Health Care System

et al. 2022

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IMPORTANCE Population-based skin cancer screening is currently not recommended owing to lack of data to quantify the balance of benefits and harms.OBJECTIVE To compare thickness-specific incidence of melanoma in screened vs unscreened patients following the initiation of a primary care-based skin cancer screening initiative. DESIGN, SETTING, AND PARTICIPANTSThis observational study of a quality improvement initiative was conducted from January 1, 2014, through December 31, 2018, among patients 35 years and older presenting for a primary care visit at primary care practices within an academic and community-based health care system during the study period. Data analysis was performed January 2020 to January 2022.INTERVENTIONS Primary care clinicians were offered training in melanoma identification through skin examination and encouraged to offer annual screening to patients 35 years and older.MAIN OUTCOMES AND MEASURES Thickness of melanomas diagnosed in screened and unscreened patients. RESULTS Among 595 799 analyzed screen-eligible patients, 144 851 (24.3%) were screened at least once. Screened patients were older (median [IQR] age, 59 [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] vs 55 [45-66] years) and more likely to be female (82 244 [56.8%] vs 250 806 [55.6%]; P < .001) and non-Hispanic White (124 747 [86.1%] vs 375 890 [83.4%]; P < .001) than unscreened patients. After adjusting for age, sex, and race, screened patients were more likely than unscreened patients to be diagnosed with in situ (incidence, 30.4 vs 14.4; hazard ratio [HR], 2.6; 95% CI, 2.1-3.1; P < .001) or thin invasive (Յ1 mm) melanoma (incidence, 24.5 vs 16.1; HR, 1.8; 95% CI, 1.5-2.2; P < .001). Screened patients were also more likely than unscreened patients to be diagnosed with in situ (incidence, 26.7 vs 12.9; HR, 2.1; 95% CI, 1.7-2.6; P < .001) or thin invasive (Յ1 mm) interval melanomas (melanoma diagnosed at least 60 days after initial screening examination) (incidence, 18.5 vs 14.4; HR, 1.3; 95% CI, 1.0-1.7; P = .03). Incidence of melanoma thicker than 4 mm in unscreened and screened patients, respectively, was 3.3 and 2.7 (HR, 0.8; 95% CI, 0.4-1.4; P = .38) for all melanomas and 2.7 and 1.5 (HR, 0.6; 95% CI, 0.2-1.2; P = .15) for interval melanomas. CONCLUSIONS AND RELEVANCEIn this quality improvement study, primary care-based melanoma screening was associated with increased detection of thin melanoma, raising concern about overdiagnosis. Further studies with longer follow-up are needed to determine the influence of screening on the incidence of thick melanoma and outcomes associated with high costs and poor outcomes, such as metastasis.

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Section: Discussionmentioning

confidence: 78%

Five-Year Outcomes of a Melanoma Screening Initiative in a Large Health Care System

et al. 2022

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“…It has been noted that in the long term these effects lessen, especially after patient education, follow-up examination, and reassurance ( Wardle et al, 2015 ; Brett et al, 2005 ; Lee et al, 2016 ). Our own research has shown that no detrimental differences were found between survey respondents in this study who were biopsied compared to those who were not ( Matthews et al, 2018 ), though the sample size was not large enough to examine those with false-positive results compared with others.…”

Section: Discussionmentioning

confidence: 61%

Psychosocial consequences of skin cancer screening

Risica

Matthews

Dionne

et al. 2018

Preventive Medicine Reports

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Screening for melanoma may save lives, but may also cause patient distress. One key reason that preventative visual skin examinations for skin cancer are not currently recommended is the inadequate available evidence to assess potential harm to psychosocial wellbeing. We investigated potential psychological harms and benefits of skin examinations by conducting telephone surveys in 2015 of 187 screened participants; all were ≥35 years old. Participants had their skin examined by practitioners who had completed INFORMED, a validated web-based training for detection of skin cancers, particularly melanoma. Participants underwent the Spielberger State-Trait Anxiety Inventory (STAI), Psychological Consequences of Screening (PCQ), Hospital Anxiety and Depression (HAD) scale, and the 12-Item Short Form Health Survey (SF-12). Analyses were conducted in 2017. Of the entire study sample, 40% were thoroughly screened as determined by patient-reported level of undress and skin areas examined. Participants who were thoroughly screened: did not differ on negative psychosocial measures; scored higher on measures of positive psychosocial wellbeing (PCQ); and were more motivated to conduct monthly self-examinations and seek annual clinician skin examinations, compared to other participants (p < 0.05). Importantly, thoroughly screened patients were more likely to report skin prevention practices (skin self-examinations to identify a concerning lesion, practitioner provided skin exam), recommend skin examinations to peers, and feel satisfied with their skin cancer education than less thoroughly screened individuals (p < 0.01). Our results suggest that visual screening for skin cancer does not worsen patient psychosocial wellbeing and may be associated with improved skin cancer-related practices and attitudes.

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“…Twenty studies (29 articles) were included, comprising 3 studies from the previous review and 17 new studies, after evaluation of 20 320 abstracts and 522 full-text articles (Figure 2). Three studies (10 articles) were included for KQ1; 6 studies (7 articles) for KQ2; 2 studies (3 articles) for KQ3; and 9 studies (9 articles) for KQ4 (Table 1). Additional details on results and contextual issues are available in the full evidence report…”

Section: Resultsmentioning

confidence: 99%

“…One was conducted in Germany (n = 45) and assessed cosmetic acceptance of shave biopsy in a screened population at a 6-month follow-up; lesions suspected of melanoma were excluded. The other was conducted in the US (n = 187) and assessed psychological well-being at 5 and 8 months after screening.…”

Section: Resultsmentioning

confidence: 99%

Skin Cancer Screening

Henrikson

Ivlev²,

Blasi

et al. 2023

JAMA

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ImportanceSkin cancer is the most common cancer type and is a major cause of morbidity.ObjectiveTo systematically review the benefits and harms of screening for skin cancer to inform the US Preventive Services Task Force.Data SourcesMEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from June 1, 2015, through January 7, 2022; surveillance through December 16, 2022.Study SelectionEnglish-language studies conducted in asymptomatic populations 15 years or older.Data Extraction and SynthesisTwo reviewers independently appraised the articles and extracted relevant data from fair- or good-quality studies; results were narratively summarized.Main Outcomes and MeasuresMorbidity; mortality; skin cancer stage, precursor lesions, or lesion thickness at detection; harms of screening.ResultsTwenty studies in 29 articles were included (N = 6 053 411). Direct evidence on screening effectiveness was from 3 nonrandomized analyses of 2 population-based skin cancer screening programs in Germany (n = 1 791 615) and suggested no melanoma mortality benefit at the population level over 4 to 10 years’ follow-up. Six studies (n = 2 935 513) provided inconsistent evidence on the association between clinician skin examination and lesion thickness or stage at diagnosis. Compared with usual care, routine clinician skin examination was not associated with increased detection of skin cancer or precursor lesions (5 studies) or stage at melanoma detection (3 studies). Evidence on the association between clinician skin examination and lesion thickness at detection was inconsistent (3 studies). Nine studies (n = 1 326 051) found a consistent positive association between more advanced stage at melanoma detection and increasing risk of melanoma-associated and all-cause mortality. Two studies (n = 232) found little to no persistent cosmetic or psychosocial harms associated with screening.Conclusions and RelevanceA substantial nonrandomized evidence base suggests a clear association between earlier stage at skin cancer detection and decreased mortality risk. However, nonrandomized studies suggest little to no melanoma mortality benefit associated with skin cancer screening with visual skin examination in adolescents or adults and no association between routine clinician skin examination and earlier stage at melanoma detection. Evidence is inconsistent regarding whether clinician skin examination is associated with thinner melanoma lesions at detection.

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

Cited by 6 publications

References 7 publications

Five-Year Outcomes of a Melanoma Screening Initiative in a Large Health Care System

Five-Year Outcomes of a Melanoma Screening Initiative in a Large Health Care System

Psychosocial consequences of skin cancer screening

Skin Cancer Screening

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