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Table 2. Summary of evidence for screening for skin cancer
in analytic framework
Accuracy of total-body skin examination: evidence that total-body skin examination
can detect skin cancer.
The accuracy of a total-body skin examination by primary care physicians
in unselected patients may be low. Reliability of pathologic diagnosis in
community practice in the United States is not known.
Accuracy of risk assessment: evidence that a questionnaire or interview,
followed by examination in selected patients, can detect skin cancer.
Mole counts and other factors predict elevated risk over time, but no study
has determined the accuracy of risk stratification followed by total-body
skin examination in selected patients as a screening method.
Effect of screening on patients' skin knowledge and self-care behavior (use
of sun protection, sun avoidance, and self-examination).
Patients with skin lesions who attended skin cancer screenings increased
their rate of performing skin self-examination. However, there is no evidence
about the effect of screening or skin knowledge on sun protection behaviors.
Adverse effects of screening: evidence that screening causes significant
Most postulated adverse effects have not been evaluated in studies.
Effectiveness of early detection: evidence that persons detected through
screening have better outcome than those who are not screened.
there are no studies that directly link screening to lower mortality and
morbidity. Most well-done, population-based studies concern promotion of
self-care behaviors such as self-examination rather than universal screening.
Effectiveness of treatment of nonmelanoma skin cancer found by screening.
The hypothesis that early detection by screening could reduce mortality
and morbidity is plausible but has not been examined in studies.
Effectiveness of treatment of melanoma found by screening.
There are no controlled studies of treatment in patients found by screening
to have thin melanomas, but epidemiologic studies, studies of skin health
behaviors, and studies of factors associated with advanced melanoma suggest
that elderly men are at high risk and are unlikely to benefit from health
of delay in diagnosis have conflicting results, and the ability of screening
to reach individuals at high risk and to find aggressive tumors while they
are still curable have not been established.
[a] I: Randomized controlled trial; II-1: Controlled trial without randomization; II-2: Cohort or case-control analytic studies; II-3: Multiple time-series, dramatic uncontrolled experiments; III: Opinions of respected authorities, descriptive epidemiology.
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