Strategies for improving melanoma education and screening for men age ≤ 50 years -: Findings from the American Academy of Dermatology National Skin Cancer Screening Program

BACKGROUND. Recently, the Institute of Medicine (2000) and the Third United States Preventive Services Task Force (2001) called for studies to help clinicians identify patients, especially elderly patients, who are at high risk for melanoma. In the current study, the authors sought to identify factors associated with a high yield in skin cancer screening and to explore strategies for improving mass screenings for melanoma. METHODS. The authors analyzed the data base of the 242,374 skin cancer screenings conducted on more than 206,000 Americans who attended the American Academy of Dermatology National Skin Cancer Screening Programs during the period 1992-1994. RESULTS. Ninety-six percent of 3476 screenees with a presumptive diagnosis of melanoma or possible melanoma were contacted, and follow-up records were obtained for 73% of screenees. Of these, 363 screenees had histologically proven melanoma. Middle-aged and older men (age greater than or equal to 50 years) comprised only 25% of screenees but comprised 44% of those with a confirmed diagnosis of melanoma. overall yield of melanoma (the number of confirmed diagnoses per the number of screenees) was 1.5 per 1000 screenings (363 diagnoses of 242,374 screenees) compared with a yield of 2.6 per 1000 screenings among men age 50 years. The yield was improved further for men age greater than or equal to 50 years who reported either a changing mole (4.6 per 1000 screenings) or skin types I and II (3.8 per 1000 screenings). The predictive value of a screening diagnosis of melanoma was more than twice as high for men age greater than or equal to 50 years with either a changing mole or skin types I and II compared with all other participants. CONCLUSIONS. The yield of mass screening for melanoma would be improved by outreach to middle-aged and older men, with particular focus on men with changing moles or with skin types I and II. Primary care physicians should be attuned to the risk factors among all of their patients but should be alerted in particular to the heightened risk of melanoma for men age greater than or equal to 50 years. Formal assessment of the impact of targeted screening on mortality warrants further study.