Revisión sistemática

No clasificado

Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma: A systematic review and meta-analysis.

Año 2013
Revista European journal of cancer (Oxford, England : 1990)
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Abstract: In this systematic review and meta-analysis the risk of a subsequent basal cell carcinoma (BCC), squamous cell carcinoma (SCC) or melanoma in patients with a previous keratinocyte carcinoma (KC) was investigated. PubMed, Embase, Web of Science and the Cochrane library were searched for studies published before 1st January 2012 that reported risks (i.e. proportions, cumulative risks or standardised incidence ratios [SIR]) of developing a subsequent BCC, SCC or melanoma in patients with prior KC. 45 articles fulfilled the inclusion criteria. In BCC patients, the pooled proportion for a subsequent BCC, SCC or melanoma was respectively 29.2% (95% confidence interval (CI) 24.6–34.3%), 4.3% (1.7–10.1%) and 0.5% (0.4–0.8%). The pooled proportion of a subsequent SCC, BCC or melanoma in SCC patients was respectively 13.3% (95% CI 7.4–22.8%), 15.9% (5.6–37.6%) and 0.5% (0.3–0.6%). The pooled SIRs for a subsequent BCC, SCC or melanoma were respectively 17.4 (95% CI 0.0–37.4), 3.2 (0.0–6.5) and 2.4 (2.3–2.6) in BCC and 4.2 (95% CI 2.0–6.5), 15.0 (14.0–16.0) and 2.7 (2.3–3.2) in SCC patients. In the subgroup analyses, strongest differences in risks were found in the continent strata (risks Australia>North America>Europe).

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Revisión sistemática

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Screening for Skin Cancer

Año 2001
Autores Helfand M , Mahon S , Eden K
Libro U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews
Enlaces Pubmed

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CONTEXT:

Malignant melanoma is often lethal, and its incidence in the United States has increased rapidly over the past 2 decades. Nonmelanoma skin cancer is seldom lethal, but, if advanced, can cause severe disfigurement and morbidity. Early detection and treatment of melanoma might reduce mortality, whereas early detection and treatment of nonmelanoma skin cancer might prevent major disfigurement and, to a lesser extent, prevent mortality. Current recommendations from professional societies regarding screening for skin cancer vary.

OBJECTIVE:

To examine published data on the effectiveness of screening for skin cancer by a primary care provider.

DATA SOURCES:

We searched the MEDLINE database for papers published from January 1994 to June 1999, using search terms for screening, physical examination, morbidity, and skin neoplasms. For information on accuracy of screening tests, we used the search terms sensitivity and specificity. We identified the most important studies from before 1994 from the Guide to Clinical Preventive Services, second edition, and from high-quality reviews. We used reference lists and expert recommendations to locate additional articles.

STUDY SELECTION:

Two reviewers independently reviewed a subset of 500 abstracts. After consistency was established, 1 reviewer reviewed the remaining abstracts. We included studies if they contained data on yield of screening, screening tests, risk factors, risk assessment, effectiveness of early detection, or cost effectiveness.

DATA EXTRACTION:

We abstracted the following descriptive information from full-text published studies of screening and recorded it in an electronic database: type of screening study, study design, setting, population, patient recruitment, screening test description, examiner, advertising targeted at high-risk groups or not targeted, reported risk factors of participants, and procedure for referrals. We also abstracted the yield-of-screening data, including probabilities and numbers of referrals, types of suspected skin cancers, biopsies, confirmed skin cancers, stages, and thickness of skin cancers. For studies that reported test performance, we recorded the definition of a suspicious lesion; the gold standard determination of disease; and the number of true-positive, false-positive, true-negative, and false-negative test results. When possible, we recorded positive predictive values, likelihood ratios, sensitivity, and specificity.

DATA SYNTHESIS:

No randomized or case-control studies demonstrate that screening for melanoma reduces morbidity or mortality. Basal cell carcinoma and squamous cell carcinoma are common, but detection and treatment in the absence of formal screening is almost always curative. No controlled studies have shown that formal screening programs improve this already high cure rate. Although the efficacy of screening has not been established, the screening procedures themselves are noninvasive, and the follow-up test—skin biopsy—has low morbidity. Estimates of accuracy of screening are based on cross-sectional studies that suffer from workup bias. One prospective study tracked patients who had negative results to determine the number of patients who had false-negative results. In this study, the sensitivity of screening for skin cancer was 0.94 and specificity was 0.975. Several recent case-control studies confirm earlier evidence that patients who have atypical moles, many (>50) common moles, or both are at increased risk for melanoma. One well-done prospective study demonstrated that risk assessment by limited physical examination identified a relatively small (<10%) group of primary care patients for more thorough evaluation.

CONCLUSIONS:

The quality of the evidence for routine screening by primary care providers for early detection of melanoma or nonmelanoma skin cancer ranged from poor to fair. Despite the lack of evidence, skin cancer screening, perhaps by means of a risk-assessment technique to identify high-risk patients who are seeing a physician for other reasons, is the most promising strategy for addressing the excess burden of disease in older adults.

KEYWORDS:

Skin Cancer, skin neoplasms, mass screening, physical examination

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Revisión sistemática

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Incidence of Programmed Cell Death 1 Inhibitor-Related Pneumonitis in Patients With Advanced Cancer: A Systematic Review and Meta-analysis.

Año 2016
Revista JAMA oncology
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IMPORTANCE:

Programmed cell death 1 (PD-1) inhibitor-related pneumonitis is a rare but clinically serious and potentially life-threatening adverse event. Little is known about its incidence across different tumor types and treatment regimens.

OBJECTIVE:

To compare the incidence of PD-1 inhibitor-related pneumonitis among different tumor types and therapeutic regimens.

DATA SOURCES:

A PubMed search through November 10, 2015, and a review of references from relevant articles. For the PubMed search, the following keywords or corresponding Medical Subject Heading terms were used: nivolumab, pembrolizumab, and PD-1 inhibitor.

STUDY SELECTION:

Twenty-six original articles of PD-1 inhibitor trial results were identified. Among them, 20 studies of melanoma, non-small cell lung cancer (NSCLC), or renal cell carcinoma (RCC) were eligible for a meta-analysis.

DATA EXTRACTION AND SYNTHESIS:

The data were extracted by 1 primary reviewer and then independently reviewed by 2 secondary reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparisons of the incidence were based on marginal, exact generalized linear models with generalized estimating equations.

MAIN OUTCOMES AND MEASURES:

Incidence of all-grade and grade 3 or higher pneumonitis and pneumonitis-related deaths.

RESULTS:

Twenty studies of single-tumor-type trials of PD-1 inhibitor (12 melanoma studies, 5 NSCLC studies, and 3 RCC studies) (a total of 4496 unique patients) were included in the meta-analysis. The overall incidence of pneumonitis during PD-1 inhibitor monotherapy was 2.7% (95% CI, 1.9%-3.6%) for all-grade and 0.8% (95% CI, 0.4%-1.2%) for grade 3 or higher pneumonitis. The incidence was higher in NSCLC for all-grade (4.1% vs 1.6%; P = .002) and grade 3 or higher pneumonitis (1.8% vs 0.2%; P < .001) compared with melanoma. The incidence in RCC was higher than in melanoma for all-grade pneumonitis (4.1% vs 1.6%; P < .001) but not for grade 3 or higher pneumonitis. Four pneumonitis-related deaths were observed in patients with NSCLC in the monotherapy group. Pneumonitis was more frequent during combination therapy than monotherapy for all-grade (6.6% vs 1.6%; P < .001) and grade 3 or higher pneumonitis (1.5% vs 0.2%; P = .001) in melanoma, with 1 pneumonitis-related death during combination therapy. Multivariable analyses demonstrated higher odds of pneumonitis in NSCLC for all-grade (odds ratio [OR], 1.43; 95% CI, 1.08-1.89; P = .005) and grade 3 or higher pneumonitis (OR, 2.85; 95% CI, 1.60-5.08; P < .001) and in RCC for all-grade pneumonitis (OR, 1.59; 95% CI, 1.32-1.92; P < .001) compared with melanoma. The combination therapy had significantly higher odds than monotherapy for all-grade (OR, 2.04; 95% CI, 1.69-2.50; P < .001) and grade 3 or higher pneumonitis (OR, 2.86; 95% CI, 1.79- 4.35; P < .001).

CONCLUSIONS AND RELEVANCE:

The incidence of PD-1 inhibitor-related pneumonitis was higher in NSCLC and RCC and during combination therapy. These findings contribute to enhance awareness among clinicians and support further investigations to meet the clinical needs.

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Revisión sistemática

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The effectiveness and safety of proton radiation therapy for indications of the eye : AAA systematic review

Año 2009
Revista Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al]
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Background and Purpose: Proton radiation has been used for the treatment of uveal melanoma since 1975, but few studies have been conducted to assess its efficacy and safety. This paper aims to systematically review the effects and side effects of proton therapy for any indication of the eye. Material and Methods: A range of databases were searched from inception to 2007. All studies that included at least ten patients and that assessed the efficacy or safety of proton therapy for any indication of the eye were included. Results: The search generated 2,385 references, of which 37 met the inclusion criteria. Five controlled trials, two comparative studies and 30 case series were found, most often reporting on uveal melanoma, choroidal melanoma and age-related macular degeneration (AMD). Methodological quality of these studies was poor. Studies were characterized by large differences in radiation techniques applied within the studies, and by variation in patient characteristics within and between studies. Results for uveal melanoma and choroidal melanoma suggest favorable survival, with, however, significant rates of side effects. Results for choroidal hemangioma and AMD did not reveal beneficial effects from proton radiation. Conclusion: There is limited evidence on the effectiveness and safety of proton radiation due to the lack of well-designed and well-reported studies. There is a need to lift evidence on proton therapy to a higher level by performing dose-finding randomized controlled trials (RCTs), comparative studies of proton radiation versus standard given alternatives and prospective case studies enrolling only patients treated with up-to-date techniques, allowing extrapolation of results to similar patient groups. © 2009 Urban & Vogel, Muenchen.

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Estudio primario

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Diagnostic ability of general practitioners and dermatologists in discriminating pigmented skin lesions.

Año 2001
Revista Journal of the American Academy of Dermatology
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BACKGROUND:

Early recognition of melanoma is the key in preventing metastatic disease.

OBJECTIVE:

The aim of this study was to evaluate diagnostic ability of general practitioners (GPs) and dermatologists concerning pigmented skin lesions in general and melanoma in particular. We also investigated whether the diagnostic ability of GPs changed after a lecture on melanoma.

METHODS:

A test set of 13 pigmented skin lesions on 35-mm color slides was presented to 160 GPs and 60 dermatologists during educational courses.

RESULTS:

GPs correctly evaluated biologic behavior of the pigmented skin lesions in 72% of the evaluations. In 71% of these evaluations they correctly identified the lesions. The proportion of lesions correctly identified was positively correlated with the frequency of pigmented skin lesions in everyday practice. Dermatologists made a correct identification of the lesions in 88% of all evaluations, and they correctly evaluated biologic behavior in 94% of these. Recognition of melanoma was proportional to melanoma exposure in everyday practice. Thick melanomas were better recognized than thin melanomas in both physician groups. After a lecture on melanoma, sensitivity of GPs to recognize malignant disease increased from 72% to 84%, without a significant decrease in specificity. The proportion of lesions correctly identified also rose significantly (66% vs 52%).

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Revisión sistemática

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Prognostic Value of the Staging System for Eyelid Tumors in the 7th Edition of the American Joint Committee on Cancer Staging Manual.

Año 2017
Autores Ford J , Thakar S , Thuro B , Esmaeli B
Revista Ophthalmic plastic and reconstructive surgery
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PURPOSE:

To determine the prognostic value of the staging criteria for eyelid tumors in the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual and to determine, for each type of eyelid tumor, which AJCC T categories are associated with increased risk of nodal metastasis and thus potential usefulness of sentinel lymph node biopsy.

METHODS:

Systematic review and analysis of articles found by searching PubMed and Google Scholar using the search terms "AJCC," "eyelid," "carcinoma," and "melanoma."

RESULTS:

Rates of local recurrence, regional nodal metastasis, and distant metastasis were approximately 7% to 10%, 1% to 9%, and 0% to 0.8%, respectively, for eyelid squamous cell carcinoma; 5% to 6%, 8% to 23%, and 2% and 14%, respectively, for eyelid sebaceous carcinoma; 10%, 10% to 22%, and 19% to 22%, respectively, for eyelid Merkel cell carcinoma (when staged according to the criteria for eyelid carcinoma as opposed to Merkel cell carcinoma), 14%, 5%, and 0%, respectively, for eyelid sweat gland carcinoma; and 2%, 9%, and 6%, respectively, for eyelid melanoma. Overall, the risks of local recurrence and regional nodal and distant metastasis appeared to increase with increasing AJCC T category, although not statistically significant in all studies. Clinical T2b or greater T category was significantly associated with increased risk of nodal metastasis for eyelid squamous cell carcinomas, sebaceous carcinomas, Merkel cell carcinomas (staged with eyelid carcinoma criteria), sweat gland carcinomas, and melanomas. Clinical T3 or greater T category was significantly associated with distant metastasis for eyelid carcinomas and melanomas.

CONCLUSION:

For eyelid carcinomas and eyelid melanomas, AJCC 7th edition T category correlates with the risks of nodal and distant metastasis, with T2b and larger tumors associated with highest risk of nodal metastasis. Patients with T2b or larger tumors may be candidates for sentinel lymph node biopsy or close nodal surveillance.

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Revisión sistemática

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Risk of peripheral edema in cancer patients treated with MEK inhibitors: a systematic review and meta-analysis of clinical trials.

Año 2017
Autores Yang Y , Liu YH , Sun X , Yu MW , Yang L , Cheng PY - Más
Revista Current medical research and opinion
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BACKGROUND:

MEK inhibitors are a group of drugs that have shown reliable effects in the treatment of metastatic melanoma and non-small-cell lung cancer. Peripheral edema is an adverse event associated with MEK inhibitors, however, there has been no systematic attempt to evaluate peripheral edema data observed with these agents. This meta-analysis aimed to determine the risk of peripheral edema in cancer patients treated with MEK inhibitors.

MATERIAL AND METHODS:

We searched PubMed, the Cochrane Library, EMBASE, and Clinical Trials.gov without language restriction. The final search was conducted on 9(th) January 2017. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data. Heterogeneity was calculated and reported via Tau(2), Chi(2), and I(2) analyses.

RESULTS:

A total of 13 eligible studies were obtained. Patients treated with MEK inhibitors (Trametinib and Selumetinib) had an increased risk overall of peripheral edema (RR = 3.05, 95%CI: 1.98-4.70; p < 0.00001), but the MEK inhibitors (Trametinib and Selumetinib) did not increase the risk of high grade edema (RR = 1.88, 95% CI 0.66-5.35; p =0.24). Subgroup analysis based on cancer type (melanoma vs non-melanoma) found that the peripheral edema risk in melanoma patients is higher than that in non-melanoma patients (P = 0.03). However, no significant difference was observed in terms of high-grade edema and other subgroups (trametinib vs selumetinib; monotherapy vs combination). Due to the absence of cobimetinib data, the result about cobimetinib was not involved.

CONCLUSION:

This meta-analysis reveals that the use of MEK inhibitors is associated with an increased risk of peripheral edema in cancer patients. Oncologists should be aware of the risk and perform regular assessment.

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Revisión sistemática

No clasificado

Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review.

Año 2012
Revista Journal of the European Academy of Dermatology and Venereology : JEADV
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BACKGROUND:

Oral 8-methoxypsoralen-UV-A (PUVA) and narrowband UV-B (NB-UVB or UVB TL-01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB-UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime.

OBJECTIVES:

To assess the respective cutaneous carcinogenic risks of PUVA or NB-UVB in psoriasis; to estimate the respective dose-relationship between skin cancers and PUVA or NB-UVB; to estimate a maximum number of sessions for PUVA or NB-UVB not to be exceeded in a lifetime.

METHODS:

A systematic literature search was carried out in Medline, Embase and Cochrane Library databases from1980 to December 2010 in English and French, with the keywords 'Psoriasis' AND 'UVB therapy' AND 'UVA therapy' AND 'cancer' AND 'skin' OR 'neoplasm' OR 'cutaneous carcinoma' OR 'melanoma'.

RESULTS:

Of 243 identified references, 49 published studies were included. Most of them (45/49) concerned PUVA therapy, with 41 assessing the risk of non-melanoma skin cancers (NMSC) following PUVA. All publications referring to the US prospective PUVA follow-up study revealed an increased risk of NMSC with the following characteristics: risk most pronounced for squamous cell carcinomas developing even with low exposures and increasing linearly with the number of sessions, tumors occurring also on non-exposed skin including invasive penile tumors, risk persisting after cessation of treatment. An increased risk of basal cell carcinomas was observed in patients receiving more than hundred PUVA sessions. The four prospective European studies selected in our review and most of the pre-1990 European and US retrospective studies failed to find a link between exposure to PUVA and skin cancer. Only the most recent cohorts, including three large long-term retrospective European studies comparing records with their respective national cancer registries reported on an independent increased risk of NMSC with PUVA, The risk was lower as compared to the US prospective PUVA follow-up study. Six studies assessed the risk of melanoma following PUVA therapy: two of the three US publications coming from the same PUVA prospective follow-up study revealed an increased risk with more than doubled incidence of both invasive and in situ melanoma among patients exposed to at least 200 PUVA treatments compared with patients exposed to lower doses, whereas the three retrospectives European studies, comparing the incidence of melanoma in PUVA users with national cancer registers, did not find any increased risk of melanoma. No increased risk of skin cancer was evidenced in the four studies specifically assessing the potential carcinogenic risk of NB-UVB.

CONCLUSION:

There is an increased risk of skin cancer following PUVA, shown by both US and European studies. The greater risk measured by the US studies may be at least partly explained by high UVA dose exposure and the lighter phototypes of the treated patients. The lack of prospective studies in psoriasis patients treated with NB-UVB constitutes a barrier to the robust assessment of carcinogenic risk of this phototherapy technique.

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Revisión sistemática

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Consejería conductual para prevenir el cáncer de piel: una revisión sistemática para la Comisión de Servicios Preventivos de EEUU.

Traducción colaborativa
Año 2011
Autores Lin JS , Eder M , Weinmann S
Revista Annals of internal medicine
Enlaces DOI , Pubmed

Este artículo está incluido en 1 Resumen estructurado de revisiones sistemáticas 11 Resúmenes estructurados de revisiones sistemáticas (1 referencia)

Este artículo incluye 11 Estudios primarios 11 Estudios primarios (11 referencias)

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ANTECEDENTES:

Al año, se diagnostican más de 2 millones de casos de cáncer de piel en Estados Unidos, y la incidencia de melanoma va en aumento.

PROPÓSITO:

Asistir a la Comisión de Servicios Preventivos de EEUU en la actualización de sus recomendaciones de 2003 sobre consejería conductual para prevenir el cáncer de piel.

FUENTES DE DATOS:

Revisiones sistemáticas existentes, búsqueda en bases de datos hasta Febrero de 2010 y expertos no relacionados con la revisión.

SELECCIÓN DE ESTUDIOS:

Se incluyeron estudios en idioma inglés, relevantes para atención primaria, sobre consejo para promover conductas de protección solar y estudios que examinaran la asociación entre conductas de protección solar y resultados en cáncer de piel o potenciales efectos adversos.

EXTRACCIÓN DE INFORMACIÓN:

Cada estudio fue evaluado usando criterios de calidad diseño-específicos. Los detalles importantes de los estudios fueron resumidos en tablas de evidencia.

SÍNTESIS DE INFORMACIÓN:

11 estudios controlados randomizados de aceptable o buena calidad examinaron el efecto de intervenciones de consejería sobre conductas de protección solar. En mujeres jóvenes, las intervenciones conductuales centradas en la apariencia disminuyen el bronceado artificial y la exposición ultravioleta. En adolescentes, la ayuda computacional puede disminuir la exposición al sol al mediodía y aumentar el uso de protector solar. Treinta y cinco estudios observacionales de calidad aceptable examinaron la relación entre exposición ultravioleta o uso de protector solar y cáncer de piel. La mayor exposición solar intermitente en la infancia se asocia con un mayor riesgo de carcinoma espinocelular, carcinoma basocelular y melanoma. La evidencia sugiere que el uso regular o precoz de bronceado artificial puede aumentar el riesgo de melanoma. En base a un estudio de calidad aceptable, el uso regular de protector solar puede prevenir carcinoma espinocelular, pero aún no está claro si puede prevenir carcinoma basocelular o melanoma.

LIMITACIONES:

Hay pocos estudios de consejería rigurosos. Los estudios observacionales están limitados por la complejidad de medir exposición ultravioleta y uso de protector solar, y por el ajuste inadecuado por variables confundentes importantes.

CONCLUSIÓN:

Estudios controlados randomizados sugieren que la consejería en atención primaria puede aumentar conductas de protección solar y disminuir el bronceado artificial.

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Revisión sistemática

No clasificado

Screening for skin cancer.

Año 2001
Revista American journal of preventive medicine
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CONTEXT:

Malignant melanoma is often lethal, and its incidence in the United States has increased rapidly over the past 2 decades. Nonmelanoma skin cancer is seldom lethal, but, if advanced, can cause severe disfigurement and morbidity. Early detection and treatment of melanoma might reduce mortality, while early detection and treatment of nonmelanoma skin cancer might prevent major disfigurement and to a lesser extent prevent mortality. Current recommendations from professional societies regarding screening for skin cancer vary.

OBJECTIVE:

To examine published data on the effectiveness of routine screening for skin cancer by a primary care provider, as part of an assessment for the U.S. Preventive Services Task Force.

DATA SOURCES:

We searched the MEDLINE database for papers published between 1994 and June 1999, using search terms for screening, physical examination, morbidity, and skin neoplasms. For information on accuracy of screening tests, we used the search terms sensitivity and specificity. We identified the most important studies from before 1994 from the Guide to Clinical Preventive Services, second edition, and from high-quality reviews. We used reference lists and expert recommendations to locate additional articles.

STUDY SELECTION:

Two reviewers independently reviewed a subset of 500 abstracts. Once consistency was established, the remainder were reviewed by one reviewer. We included studies if they contained data on yield of screening, screening tests, risk factors, risk assessment, effectiveness of early detection, or cost effectiveness.

DATA EXTRACTION:

We abstracted the following descriptive information from full-text published studies of screening and recorded it in an electronic database: type of screening study, study design, setting, population, patient recruitment, screening test description, examiner, advertising targeted at high-risk groups or not targeted, reported risk factors of participants, and procedure for referrals. We also abstracted the yield of screening data including probabilities and numbers of referrals, types of suspected skin cancers, biopsies, confirmed skin cancers, and stages and thickness of skin cancers. For studies that reported test performance, we recorded the definition of a suspicious lesion, the "gold-standard" determination of disease, and the number of true positive, false positive, true negative, and false negative test results. When possible, positive predictive values, likelihood ratios, sensitivity, and specificity were recorded.

DATA SYNTHESIS:

No randomized or case-control studies have been done that demonstrate that routine screening for melanoma by primary care providers reduces morbidity or mortality. Basal cell carcinoma and squamous cell carcinoma are very common, but detection and treatment in the absence of formal screening are almost always curative. No controlled studies have shown that formal screening programs will improve this already high cure rate. While the efficacy of screening has not been established, the screening procedures themselves are noninvasive, and the follow-up test, skin biopsy, has low morbidity. Five studies from mass screening programs reported the accuracy of skin examination as a screening test. One of these, a prospective study, tracked patients with negative results to determine the number of patients with false-negative results. In this study, the sensitivity of screening for skin cancer was 94% and specificity was 98%. Several recent case-control studies confirm earlier evidence that risk of melanoma rises with the presence of atypical moles and/or many common moles. One well-done prospective study demonstrated that risk assessment by limited physical exam identified a relatively small (<10%) group of primary care patients for more thorough evaluation.

CONCLUSIONS:

The quality of the evidence addressing the accuracy of routine screening by primary care providers for early detection of melanoma or nonmelanoma skin cancer ranged from poor to fair. We found no studies that assessed the effectiveness of periodic skin examination by a clinician in reducing melanoma mortality. Both self-assessment of risk factors or clinician examination can classify a small proportion of patients as at highest risk for melanoma. Skin cancer screening, perhaps using a risk-assessment technique to identify high-risk patients who are seeing a physician for other reasons, merits additional study as a strategy to address the excess burden of disease in older adults.

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