Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
private practice, Maldegem, Belgium.
JAMA Dermatol. 2016 Jan;152(1):27-34. doi: 10.1001/jamadermatol.2015.2680.
Skin cancer is the most frequent cancer type. It remains unknown if and how screening programs can be organized in a cost-effective manner.
To compare the 2 screening strategies of systematic total-body examination (TBE) and lesion-directed screening (LDS), with a focus on the participation rate, detection rate, anxiety, and cost.
DESIGN, SETTING, AND PARTICIPANTS: Population-based cross-sectional screenings by a team of 6 dermatologists were organized in 2 sociodemographically similar regions. The TBE was organized in a community of 9325 inhabitants 18 years and older (Wichelen, East Flanders, Belgium) during a 5-day screening (March 14-18, 2014). The LDS was organized in a sociodemographically comparable community (Nevele, East Flanders, Belgium) of 9484 adult inhabitants during a 4-day screening (April 22 and 25-27, 2014). The first population received a personal invitation for a standard TBE. In the second population, individuals were invited for an LDS if they had a lesion meeting 1 or more of the following criteria: ABCD rule (A, asymmetry; B, borders; C, colors; and D, differential structures), ugly duckling sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions.
In total, 1982 individuals were screened, and 47 skin cancers (2.4%) were histologically confirmed, including 9 melanomas (0.5%), 37 basal cell carcinomas (1.9%), and 1 squamous cell carcinoma or Bowen disease (0.1%).
The positive predictive value for all suspicious lesions was 56.6% (47 of 83). The participation rate was 17.9% (1668 of 9325) in the TBE group vs 3.3% (314 of 9484) in the LDS group (P < .01). The skin cancer detection rate per 100 participants did not differ significantly between the 2 groups, with rates of 2.3% (39 of 1668) in the TBE group vs 3.2% (8 of 248) in the LDS group (P = .40). The operational effectiveness per 100 invitees was 0.4% (39 of 9325) in the TBE group vs 0.1% (8 of 9484) in the LDS group (P < .01). In addition, LDS was 5.6 times less time consuming than TBE. Participants in the LDS group had significantly higher baseline anxiety levels compared with participants in the TBE group (3.7 vs 3.3 points on a visual analog scale, P < .01). In screenees without a suspicious lesion, anxiety levels significantly dropped after screening.
Total-body examination yielded a higher absolute number of skin cancers. Lesion-directed screening had a similar detection rate of 3.2% (8 of 248) but was 5.6 times less time consuming. When performed by dermatologists, LDS is an acceptable alternative screening method in health care systems with limited budgets or long waiting lists.
皮肤癌是最常见的癌症类型。目前尚不清楚是否以及如何以具有成本效益的方式组织筛查计划。
比较系统性全身检查（TBE）和病变定向筛查（LDS）这两种筛查策略，重点是参与率、检出率、焦虑和成本。
设计、设置和参与者：由 6 名皮肤科医生组成的团队在两个社会人口统计学上相似的地区进行了基于人群的横断面筛查。TBE 在一个有 9325 名 18 岁及以上居民的社区（比利时东佛兰德的 Wichelen）进行了为期 5 天的筛查（2014 年 3 月 14 日至 18 日）。LDS 在一个社会人口统计学上可比的社区（比利时东佛兰德的 Nevele）进行，该社区有 9484 名成年居民（2014 年 4 月 22 日和 25-27 日）。第一个社区收到了参加标准 TBE 的个人邀请。在第二个社区，如果个人有符合以下 1 个或多个标准的病变，他们将被邀请参加 LDS：ABCD 规则（A，不对称；B，边界；C，颜色；D，不同结构）、丑陋鸭征、持续超过 4 周的新病变或红色不愈合病变。
共对 1982 人进行了筛查，47 例皮肤癌（2.4%）经组织学证实，包括 9 例黑色素瘤（0.5%）、37 例基底细胞癌（1.9%）和 1 例鳞状细胞癌或 Bowen 病（0.1%）。
所有可疑病变的阳性预测值为 56.6%（83 例中的 47 例）。TBE 组的参与率为 17.9%（1668 例中有 9325 例），LDS 组为 3.3%（248 例中有 314 例）（P<.01）。两组每 100 名参与者的皮肤癌检出率无显著差异，TBE 组为 2.3%（1668 例中有 39 例），LDS 组为 3.2%（248 例中有 8 例）（P=.40）。TBE 组每 100 名受邀者的手术有效性为 0.4%（9325 名受邀者中有 39 名），而 LDS 组为 0.1%（9484 名受邀者中有 8 名）（P<.01）。此外，LDS 比 TBE 耗时少 5.6 倍。与 TBE 组相比，LDS 组参与者的基线焦虑水平明显更高（视觉模拟量表上的 3.7 分与 3.3 分，P<.01）。在没有可疑病变的筛查者中，焦虑水平在筛查后显著下降。
全身检查的绝对皮肤癌数量更高。病变定向筛查的检出率相似（8 例中有 3.2%），但耗时少 5.6 倍。当由皮肤科医生进行时，LDS 是一种可接受的替代筛查方法，适用于预算有限或等待名单较长的医疗保健系统。
