Department of Dermatology, Allergology and Environmental Medicine, Hospital Munich-Schwabing, Germany.
J Eur Acad Dermatol Venereol. 2012 Jan;26(1):86-94. doi: 10.1111/j.1468-3083.2011.04014.x. Epub 2011 Mar 4.
Skin cancer screening aims to detect potentially metastasizing skin cancers at an early and surgically curable stage. This may take the form of mass screening, as currently occurs in Germany, or of targeted screening of those at greatest risk.
To develop a model to identify patients at high risk of developing skin cancer who would benefit from regular skin cancer screening.
This was an open prospective point-prevalence study of consecutive patients presenting to dermatologists for a total skin check. Demographic and skin cancer risk factors were recorded and, for the first time, histology of skin lesions was documented. Results were analysed by univariate and multivariate analyses and, after logistic regression with stepwise forward selection, a risk-group model was developed.
The results of 108,281 total skin examinations were available for analysis. 142 definite melanomas, 108 severely dysplastic naevi/cannot-exclude-melanoma, 491 basal cell carcinomas (BCC) and 93 squamous cell carcinomas (SCC) were excised. A risk model was developed for melanoma and SCC based on mathematical e-functions. The model had >92% sensitivity for melanoma and SCC and an overall 67.24% specificity for melanoma, SCC and BCC. This targeted risk model identified one-third of the study population as being at risk for the development of melanoma and SCC.
Using the risk calculator developed from this study, targeted screening of the identified at-risk population reduces the numbers needed to be screened regularly by 50%, yet has better sensitivity for melanoma and similar sensitivity for SCC compared to the current mass screening programme in Germany.
皮肤癌筛查旨在早期发现可能转移的皮肤癌，并通过手术进行治疗。这可以采用大规模筛查的方式，如目前在德国实施的方式，也可以对高危人群进行有针对性的筛查。
开发一种模型，以识别出患有皮肤癌风险较高的患者，这些患者将从定期皮肤癌筛查中获益。
这是一项针对皮肤科就诊患者进行的开放性前瞻性患病率研究，对所有患者进行了全面的皮肤检查。记录了人口统计学和皮肤癌危险因素，并首次记录了皮肤病变的组织学特征。通过单因素和多因素分析进行了结果分析，并在进行逐步向前选择的逻辑回归后，开发了一种风险分组模型。
共分析了 108281 例全面皮肤检查的结果。切除了 142 例明确的黑色素瘤、108 例严重发育不良痣/不能排除黑色素瘤、491 例基底细胞癌（BCC）和 93 例鳞状细胞癌（SCC）。基于数学 e 函数，为黑色素瘤和 SCC 开发了一种风险模型。该模型对黑色素瘤和 SCC 的敏感性>92%，对黑色素瘤、SCC 和 BCC 的总体特异性为 67.24%。该靶向风险模型确定了三分之一的研究人群存在罹患黑色素瘤和 SCC 的风险。
使用本研究开发的风险计算器，对确定的高危人群进行有针对性的筛查，可以将需要定期筛查的人数减少 50%，但与德国目前的大规模筛查计划相比，对黑色素瘤的敏感性更高，对 SCC 的敏感性相似。
