False-negative findings in skin cancer and melanoma screening.

BACKGROUND: Few data are available on the accuracy of visual skin examination by dermatologists as a skin cancer and melanoma screening tool. OBJECTIVE: The purpose of this study was to assess the number of false-negative findings in a skin cancer-melanoma screening program. METHODS: We obtained follow-up information regarding 1551 persons with a negative screening result in a skin cancer-melanoma screening program in 1990. Follow-up was established by record linkage with two different population-based registries. RESULTS: Fifteen persons had new skin cancers. Three of their lesions had been present at the original screening and had probably been missed; 12 were genuinely new. No melanomas were among the missed cases. The calculated sensitivity of the screening was 93.3%, its specificity was 97.8%, its positive predictive value was 54.0%, and its negative predictive value was 99.8%. CONCLUSION: Visual examination by dermatologists as a screening tool for skin cancer and melanoma is appropriate.

Lack of selective attendance of participants at skin cancer/melanoma screening clinics.

BACKGROUND: Whether persons who come for skin cancer/melanoma screening are those at highest risk for the disease remains a debatable issue. OBJECTIVE: Our purpose was to evaluate the appropriateness of self-selection of persons attending screening clinics. METHODS: We studied the frequency of malignant and/or premalignant clinical diagnoses according to certain demographic characteristics as a measure of selective attendance among 2463 persons screened in the regions of Arnhem and Eindhoven in 1990. RESULTS: The referral rates for tentative malignant and/or premalignant diagnoses were more or less similar in men (11.8%) and women (9.6%); in persons with symptoms (11.6%) and those who were symptom free (9.3%); in attendants from the towns in which the screenings were held (11.4%) and those coming from distant communities (9.0%); and in persons who attended for specific skin lesions (10.7%) and those who opted for general skin examination (8.8%). The referral rate was 9.2% in persons younger than 70 years of age against 18.5% in those 70 years of age or older (p < 0.001). Most presumptive melanoma diagnoses (15 of 22) were recorded in persons 50 years of age or older. CONCLUSION: Our findings suggest that participants of free skin cancer/melanoma screening clinics, on average, are unable to estimate their own risk profile properly.

General practitioners' workload after skin cancer/melanoma screening clinics in The Netherlands.

We studied the workload of the general practitioner after two skin cancer screening clinics in the Netherlands. Thirty-one physicians participated in the project. The numbers of patients presenting with benign and malignant skin lesions were recorded 2 weeks before and 6 weeks after the public campaigns. In the week immediately after the screening there was a small increase in the number of consultations for suspected skin cancer. Thereafter, the weekly number of malignant lesions decreased to precampaign levels. Subsequently to the campaigns the numbers of referrals for benign skin lesions decreased slightly. We conclude that the extra workload for the general practitioner generated by the screening campaigns has been negligible.

Practical considerations of melanoma/skin cancer screening clinics.

In 1989 a voluntary melanoma/skin cancer screening clinic was held in Oss, the Netherlands. The campaign was carried out according to the free clinics conducted since 1985 in the USA. Our experiences with the first clinic urged us to improve on the organization of the screen. This produced a better yield of the second screen, conducted in 1990 in Arnhem. In this paper we present the practical and organizational implications of melanoma/skin cancer screening based on both screening exercises. It is emphasized that only dermatologists should screen. Concomitant public education will enhance self-selection of people at risk for melanoma/skin cancer. There should be ample provider time, sufficient auxiliary personnel and abundant examination rooms. Total-body skin examination is optional. Follow-up of positive screenees is mandatory. It is concluded that melanoma/skin cancer screening is feasible, particularly in countries with a high dermatologist-to-patient ratio.

Melanoma/skin cancer screening clinics: experiences in The Netherlands.

In 1989 and 1990 we conducted two free melanoma/skin screening clinics in Oss and Arnhem in the Netherlands. The study was carried out along the lines of the recent campaigns supported by the American Academy of Dermatology. Of 2564 persons screened, 53 had melanoma or nonmelanoma skin cancer (2.1%). Compliance with follow-up for persons with suspected melanoma/skin cancer was adequate (93 of 103; 90.3%).

Endoscopic and histopathologic features of Degos' disease.

The case is reported of a 69-year-old female with atrophic papules on the skin who developed multiple spontaneous intestinal perforations of which she eventually died. The skin lesions in combination with lesions in the gastrointestinal tract are typical for Degos' disease or malignant atrophic papulosis. The characteristic histopathological and endoscopic features of this rare disease are reported. This case demonstrates the importance of routinely performing endoscopy in Degos' disease to detect silent perforation, even in patients without gastrointestinal complaints.

Flow cytometric quantification of T6-positive cells in psoriatic epidermis after PUVA and methotrexate therapy.

We describe a flow cytometric technique for measuring the percentage of T6-positive cells in suspensions prepared by trypsinization of human epidermis. The value obtained for healthy controls (1.55 +/- 0.52%) corresponds to about 600 T6-positive cells per mm2 of skin surface, a figure in line with histological estimates. No significant change was found in the percentage of T6-positive cells in either the uninvolved or lesional epidermis of untreated psoriatic patients. PUVA treatment resulted in a significant reduction in T6-positive cells. A cyclic fluctuation in the numbers of T6-positive cells was shown to accompany methotrexate administration on a weekly divided dose schedule.