Jonna B P, Delfino R J, Newman W G, Tope W D
Mesa Community College, San Diego, California, USA.
Prev Med. 1998 Jul-Aug;27(4):611-6. doi: 10.1006/pmed.1998.0334.
There is an ongoing need for evaluating the effectiveness of skin cancer screening programs and barriers to obtaining definitive diagnoses and treatments among screen-positive patients.
We studied 132 patients who were given presumptive diagnoses of skin cancer while attending a free skin cancer screening program during May 1994 in San Diego, California (464 screened). We assessed compliance with recommendations to see a physician for definitive diagnostic workup. Logistic regression models included potential determinants of compliance: age, gender, health insurance, educational level, anatomic site, number of suspicious skin lesions, personal and family history of skin cancer, propensity to sunburn, and history of recent change in moles. The positive predictive value (PPV) of skin cancer diagnoses was defined conservatively as a range by inclusion then exclusion of patients not biopsied.
Follow-up information was obtained for 115 patients, and 88 (77%) of these reported obtaining a definitive workup. The final regression model controlling for age showed that patients without a family history of skin cancer were less compliant than those with a history [OR for noncompliance 3.29, 95% confidence interval (CI) 1.10-9.83], and patients with only one presumptive skin cancer lesion were less compliant than those with additional cancer lesions (OR 5.31, 95% CI 1.07-26.43). Older patients were more compliant than younger. Among 82 patients under 65 years of age, the above factors were important only among men. Also, noncompliance was significantly higher among younger men without versus with health insurance (OR 5.14, 95% CI 1.23-20.68). Two melanomas, 1 squamous cell carcinoma, and 23 basal cell carcinomas were histopathologically confirmed. The PPV for melanoma was 6-15%, for squamous cell carcinoma 4-12%, and for basal cell carcinoma 32-85%.
This study confirms the ability of skin cancer screening programs to successfully identify individuals with cutaneous malignancies. The significant association of noncompliance to seek recommended follow-up care with lack of health insurance for men too young to participate in Medicare suggests that approaches to definitive workup for uninsured patients be developed alongside free screening programs.
持续需要评估皮肤癌筛查项目的有效性以及筛查呈阳性患者获得明确诊断和治疗的障碍。
我们研究了1994年5月在加利福尼亚州圣地亚哥参加免费皮肤癌筛查项目（共筛查464人）时被初步诊断为皮肤癌的132名患者。我们评估了他们遵循建议去看医生进行明确诊断检查的情况。逻辑回归模型纳入了可能影响依从性的因素：年龄、性别、健康保险、教育水平、解剖部位、可疑皮肤病变数量、个人及家族皮肤癌病史、晒伤倾向以及痣近期变化史。皮肤癌诊断的阳性预测值（PPV）通过先纳入然后排除未进行活检的患者保守地定义为一个范围。
获得了115名患者的随访信息，其中88名（77%）报告进行了明确的检查。控制年龄后的最终回归模型显示，无皮肤癌家族史的患者比有家族史的患者依从性差[不依从的比值比（OR）为3.29，95%置信区间（CI）为1.10 - 9.83]，仅有一个初步诊断的皮肤癌病变的患者比有多个癌性病变的患者依从性差（OR为5.31，95% CI为1.07 - 26.43）。老年患者比年轻患者依从性更好。在82名65岁以下的患者中，上述因素仅在男性中较为重要。此外，未参保的年轻男性的不依从率显著高于参保的年轻男性（OR为5.14，95% CI为1.23 - 20.68）。经组织病理学确诊了2例黑色素瘤、1例鳞状细胞癌和23例基底细胞癌。黑色素瘤的PPV为6% - 15%，鳞状细胞癌为4% - 12%，基底细胞癌为32% - 85%。
本研究证实了皮肤癌筛查项目能够成功识别皮肤恶性肿瘤患者。对于年龄太小无法参加医疗保险的男性，不依从寻求推荐的后续治疗与缺乏健康保险之间存在显著关联，这表明应在开展免费筛查项目的同时，为未参保患者制定明确检查的方法。
