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Nowakowska MK, Li Y, Mohr C, Smith B, Ferris LK, Wehner MR. Prevalence of Total Body Skin Examinations among Dermatology Encounters in Medicare Data: A Retrospective Cohort Study. J Invest Dermatol 2024; 144:905-908.e16. [PMID: 37757914 DOI: 10.1016/j.jid.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Affiliation(s)
| | - Yao Li
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cassandra Mohr
- McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Brandon Smith
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mackenzie R Wehner
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Maximino JA, Mayer A, Lourenço A, Soares RO, Pojo M. Skin cancer screening: the experience in South Portugal. Int J Dermatol 2024. [PMID: 38323503 DOI: 10.1111/ijd.17065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The number of skin cancer cases and related deaths continues to increase worldwide, including in Portugal. The lack of efficient health care leaves the southern Portuguese population at risk of presenting skin lesions at later stages. An initiative for skin cancer screening and medical care follow-up was created by the nonprofit organization Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul (LPCC-NRS). METHODS Information was gathered from 4,398 participants in several Southern Portugal regions, from January 2021 to July 2022. Descriptive and lesion risk statistical analyses were applied. RESULTS Participants' characteristics were described, and risk assessment was performed differentially between premalignant (n = 577) and malignant lesions (n = 176). The main risk factor for both was male gender. From the described suspicious malignant lesions, 31.8% were confirmed (n = 56), among which there were 43 basal cell carcinomas (BCC), 9 cutaneous melanomas (CM), and 4 squamous cell carcinomas (SCC). CONCLUSIONS Data analysis pointed to a need for improved participant recruitment, especially of male participants, and health literacy assessment in future screenings.
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Affiliation(s)
- José A Maximino
- Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul, Lisbon, Portugal
| | - Alexandra Mayer
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, Lisbon, Portugal
| | - António Lourenço
- Registo Oncológico Nacional (RON), Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Rua Professor Lima Basto, Lisbon, Portugal
| | - Rui O Soares
- Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul, Lisbon, Portugal
| | - Marta Pojo
- Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul, Lisbon, Portugal
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Lee RC, Liyanage U, Fry K, Brown S, von Schuckmann L, Spelman L, Soyer HP, Neale RE, Gordon LG, Whiteman DC, Olsen CM, Janda M, Khosrotehrani K. Patterns and cost of care according to keratinocyte cancer risk stratification in a volunteer population screening clinic: Real-world data from the TRoPICS study. Australas J Dermatol 2023; 64:389-396. [PMID: 37092598 PMCID: PMC10952310 DOI: 10.1111/ajd.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/04/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Risk prediction tools have been developed for keratinocyte cancers (KCs) to effectively categorize individuals with different levels of skin cancer burden. Few have been clinically validated nor routinely used in clinical settings. OBJECTIVES To assess whether risk prediction tool categories associate with interventions including chemoprophylaxis for skin cancer, and health-care costs in a dermatologist-run screening clinic. METHODS Adult participants who presented to a walk-in screening facility were invited to participate. A self-completed KC risk prediction tool was used to classify participants into one of the five risk categories. Participants subsequently underwent full skin examination by a dermatologist. Dermatological interventions and skin cancer-related medical prescriptions were documented. Total health-care costs, both to the health-care system and patients were evaluated. RESULTS Of the 507 participants recruited, 5-fluorouracil cream and nicotinamide were more frequently prescribed in the higher risk groups as chemoprophylaxis (p < 0.005). A significant association with high predicted risk was also observed in the use of cryotherapy and curettage and cautery (p < 0.05). The average health-care costs associated with a skin check visit increased from $90 ± 37 (standard deviation) in the lowest risk group to $149 ± 97 in the highest risk group (p < 0.0001). CONCLUSIONS We observed a positive association between higher predicted risk of skin cancer and the prescription of chemoprophylaxis and health-care costs involved with opportunistic community skin cancer screening. A clinical use of risk stratification may be to provide an opportunity for clinicians to discuss skin cancer prevention and chemoprophylaxis with individual patients.
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Affiliation(s)
- Ruby Chia‐Lin Lee
- Frazer Institute, The University of QueenslandBrisbaneQueenslandAustralia
| | - Upekha Liyanage
- Frazer Institute, The University of QueenslandBrisbaneQueenslandAustralia
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Kirsty Fry
- Frazer Institute, The University of QueenslandBrisbaneQueenslandAustralia
| | - Susan Brown
- Frazer Institute, The University of QueenslandBrisbaneQueenslandAustralia
| | - Lena von Schuckmann
- Queensland Institute of DermatologyQueensland Skin and Cancer FoundationBrisbaneQueenslandAustralia
| | - Lynda Spelman
- Queensland Institute of DermatologyQueensland Skin and Cancer FoundationBrisbaneQueenslandAustralia
| | - H. Peter Soyer
- Dermatology Research CentreFrazer Institute, The University of QueenslandBrisbaneQueenslandAustralia
| | - Rachel E. Neale
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Louisa G. Gordon
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - David C. Whiteman
- QIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | | | - Monika Janda
- Centre of Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
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Smith B, Smith JE, Demanelis K, Ferris LK. Changes in skin cancer screening rates in the United States from 2005 to 2015. J Am Acad Dermatol 2023; 89:142-145. [PMID: 36804574 DOI: 10.1016/j.jaad.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/19/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Brandon Smith
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Kathryn Demanelis
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Ingvar J, Nielsen K, Ingvar Å. Factors for not performing total body skin examinations in primary care in association with teledermoscopy. BMC PRIMARY CARE 2023; 24:76. [PMID: 36944927 PMCID: PMC10031956 DOI: 10.1186/s12875-023-02034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To investigate factors related to omitted total body skin examination (TBSE) in skin cancer diagnostics while managing patients using teledermoscopy (TDS) in Swedish primary care. METHODS 4,987 TDS referrals from primary care centers were analyzed to identify factors associated with failing to perform TBSE. Data collected included age, gender of patient and physician, and reason for a visit. Logistic regression was used to test the association between the variables and risk of failing to complete a TBSE. RESULTS The risk for omitted TBSE is higher in older patients, females, patients whose primary reason for seeking care was not specifically for a complete skin check, and with female physician. Patients > 80 years had more than four times increased risk of not undergoing TBSE compared to the youngest (< 30 y). The strongest correlation to omitting TBSE was with other reasons for primary care visits than "skin check". Male gender of the patient and being examined by male physicians decreased the risk of omitted TBSE by 20% and 30%, respectively. There was no evidence of interaction between the gender of the patient and the physician. CONCLUSION Since TDS reduces the opportunities to have a TBSE by dermatologists, the standard management of patients with suspicious skin lesions in primary care must be revised and evidence-based. TBSE is strongly recommended for patients with increased risk of skin cancer, for example old persons with fair skin and a history of skin cancer, when managing them with TDS.
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Affiliation(s)
- Jonas Ingvar
- Dermatology and Venereology, Department of clinical sciences Lund, Lund University Skin Cancer research group (LuScaR), Lund University, Lund, Sweden.
- Kry Laurentii Primary Care Center, Lund, Sweden.
| | - Kari Nielsen
- Dermatology and Venereology, Department of clinical sciences Lund, Lund University Skin Cancer research group (LuScaR), Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Department of Dermatology and Venereology, Helsingborg Hospital, Helsingborg, Sweden
| | - Åsa Ingvar
- Dermatology and Venereology, Department of clinical sciences Lund, Lund University Skin Cancer research group (LuScaR), Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
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Development and Validation of a Simple Model to Predict the Risk of Nonmelanoma Skin Cancer on Screening Total Body Skin Examination. Dermatol Res Pract 2022; 2022:2313896. [PMID: 36017173 PMCID: PMC9398853 DOI: 10.1155/2022/2313896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 02/01/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Objective There is insufficient evidence to generate skin cancer screening guidelines at the population level, resulting in arbitrary variation in patient selection for screening skin examinations. This study was aimed at developing an easy-to-use predictive model of nonmelanoma skin cancer (NMSC) risk on screening total body skin examination (TBSE). Methods This epidemiologic assessment utilized data from a prospective, multicenter international study from primarily academic outpatient dermatology clinics. Potential predictors of NMSC on screening TBSE were identified and used to generate a multivariable model that was converted into a point-based scoring system. The performance characteristics of the model were validated in a second data set from two healthcare institutions in the United States. Results 8,501 patients were included. Statistically significant predictors of NMSC on screening TBSE included age, skin phototype, and history of NMSC. A multivariable model and point-based scoring system using these predictors exhibited high discrimination (AUC = 0.82). Conclusion A simple three-variable model, abbreviated as CAP (cancer history, age, phototype) can accurately predict the risk of NMSC on screening TBSE by dermatology. This tool may be used in clinical decision making to enhance the yield of screening TBSE.
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O'Connor C, Gallagher C, O'Connell M, Bourke J, Murphy M, Bennett M. Bare necessities? The utility of full skin examination in the COVID-19 era. Clin Exp Dermatol 2021; 46:720-722. [PMID: 33639003 PMCID: PMC8013915 DOI: 10.1111/ced.14620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
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Affiliation(s)
- C O'Connor
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - C Gallagher
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - M O'Connell
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - J Bourke
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - M Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - M Bennett
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
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Young AT, Vora NB, Cortez J, Tam A, Yeniay Y, Afifi L, Yan D, Nosrati A, Wong A, Johal A, Wei ML. The role of technology in melanoma screening and diagnosis. Pigment Cell Melanoma Res 2020; 34:288-300. [PMID: 32558281 DOI: 10.1111/pcmr.12907] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk-based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non-invasive visual-based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow-up. Specialized imaging modalities using non-visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face-to-face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology-aided diagnosis may change the calculus of screening; however, well-designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.
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Affiliation(s)
- Albert T Young
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Niki B Vora
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jose Cortez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Tam
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Yildiray Yeniay
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Ladi Afifi
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Di Yan
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Adi Nosrati
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Wong
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Arjun Johal
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Affiliation(s)
- L K Ferris
- Department of Dermatology, University of Pittsburgh School of Medicine, 3601 Fifth Avenue, 5th Floor, Pittsburgh, PA, 15213, USA
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