SKIN-CANCER SCREENING FOCUSING ON MELANOMA YIELDS MORE SELECTIVE ATTENDANCE

Background: Screening theoretically reduces death and morbidity from m alignant melanoma. The rationale of screening for nonmelanoma skin can cer is more debatable, since mortality is very low. Methods: We organi zed a screening campaign in Southern Limburg, the Netherlands, in 1993 . Press releases and public announcements referred only to melanoma. T he results were compared with similar campaigns in Arnhem and Eindhove n, the Netherlands, in 1990; these, however, addressed skin cancer in general. Results: 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 encounte red (3.7% in 1990 vs 2.6% in 1993; P=.009). Actinic keratoses were als o less numerous (6.3% vs 1.5%; P<.001). Conclusion: Screening concentr ating on melanoma increases the rates of lesions suggestive of melanom a and dysplastic nevi, whereas the proportions of basal and squamous c ell carcinomas and actinic keratoses decrease. These findings may have important implications with regard to the cost-effectiveness of skin cancer screening efforts.