Does screening by primary care providers effectively detect melanoma and other skin cancers?
Q: Does screening by primary care providers effectively detect melanoma and other skin cancers? Evidence-based answer: possibly. No trials have directly assessed detection of melanoma and other skin cancers by primary care providers. Training a group comprised largely of primary care physicians to perform skin cancer screening was associated with a 41% increase in skin cancer diagnoses but no change in melanoma mortality. Visual screening for melanoma by primary care physicians is 40% sensitive and 86% specific (compared with 49% and 98%, respectively, for dermatologists and plastic surgeons). Melanomas found by visual screening are 38% more likely to be thin (≤ 0.75 mm) than melanomas discovered without screening, which correlates with improved outcomes. Visual skin cancer screening overall is associated with false-positive rates as follows: 28 biopsies for each melanoma detected, 9 to 10 biopsies for each basal cell carcinoma, and 28 to 56 biopsies for squamous cell carcinoma. False-positive rates are higher for women--as much as double the rate for men--and younger patients--as much as 20-fold the rate for older patients (strength of recommendations for all foregoing statements: B, cohort studies).
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