de Rooij M J, Rampen F H, Schouten L J, Neumann H A
University Hospital of Maastricht, The Netherlands.
Arch Dermatol. 1995 Apr;131(4):422-5.
Screening theoretically reduces death and morbidity from malignant melanoma. The rationale of screening for nonmelanoma skin cancer is more debatable, since mortality is very low.
We organized a screening campaign in Southern Limburg, the Netherlands, in 1993. Press releases and public announcements referred only to melanoma. The results were compared with similar campaigns in Arnhem and Eindhoven, the Netherlands, in 1990; these, however, addressed skin cancer in general.
There were 4146 people attending the 1993 screenings, compared with 2463 in 1990. The proportion of screenees with lesions suggestive of melanoma increased from 1.1% in 1990 to 1.7% during the 1993 campaign (P = .04). The proportion of dysplastic nevi rose from 2.1% to 7.7% (P < .001). Nonmelanoma skin cancers were less often encountered (3.7% in 1990 vs 2.6% in 1993; P = .009). Actinic keratoses were also less numerous (6.3% vs 1.5%; P < .001).
Screening concentrating on melanoma increases the rates of lesions suggestive of melanoma and dysplastic nevi, whereas the proportions of basal and squamous cell carcinomas and actinic keratoses decrease. These findings may have important implications with regard to the cost-effectiveness of skin cancer screening efforts.
理论上，筛查可降低恶性黑色素瘤的死亡率和发病率。非黑色素瘤皮肤癌筛查的基本原理更具争议性，因为其死亡率非常低。
1993年，我们在荷兰林堡省南部组织了一次筛查活动。新闻稿和公告仅提及黑色素瘤。将结果与1990年在荷兰阿纳姆和埃因霍温开展的类似活动进行比较；然而，后者针对的是一般皮肤癌。
1993年有4146人参加筛查，而1990年为2463人。疑似黑色素瘤病变的受检者比例从1990年的1.1%增至1993年筛查期间的1.7%（P = 0.04）。发育异常痣的比例从2.1%升至7.7%（P < 0.001）。非黑色素瘤皮肤癌的检出率较低（1990年为3.7%，1993年为2.6%；P = 0.009）。光化性角化病的数量也较少（6.3%对1.5%；P < 0.001）。
专注于黑色素瘤的筛查会提高疑似黑色素瘤病变和发育异常痣的检出率，而基底细胞癌、鳞状细胞癌和光化性角化病的比例会降低。这些发现可能对皮肤癌筛查工作的成本效益具有重要意义。
