POSITIVE PREDICTIVE VALUE FOR PRESUMPTIVE DIAGNOSES OF SKIN-CANCER AND COMPLIANCE WITH FOLLOW-UP AMONG PATIENTS ATTENDING A COMMUNITY SCREENING-PROGRAM

Background There is an ongoing need for evaluating the effectiveness o f skin cancer screening programs and barriers to obtaining definitive diagnoses and treatments among screen-positive patients. Methods. We s tudied 132 patients who were given presumptive diagnoses of skin cance r 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. L ogistic regression models included potential determinants of complianc e: age, gender, health insurance, educational level, anatomic site, nu mber of suspicious skin lesions, personal and family history of skin c ancer, propensity to sunburn, and history of recent change in moles. T he positive predictive value (PPV) of skin cancer diagnoses was define d conservatively as a range by inclusion then exclusion of patients no t biopsied. Results. Follow-up information was obtained for 115 patien ts, and 88 (77%) of these reported obtaining a definitive workup. The final regression model controlling for age showed that patients withou t a family history of skin cancer were less compliant than those with a history [OR for noncompliance 3.29, 95% confidence interval (CI) 1.1 0-9.83], and patients with only one presumptive skin cancer lesion wer e less compliant than those with additional cancer lesions (OR 5.31, 9 5% CI 1.07-26.43). Older patients were more compliant than younger. Am ong 82 patients under 65 years of age, the above factors were importan t only among men. Also, noncompliance was significantly higher among y ounger 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 car cinomas were histopathologically confirmed. The PPV for melanoma was 6 -15%, for squamous cell carcinoma 4-12%, and for basal cell carcinoma 32-85%. Conclusions. This study confirms the ability of skin cancer sc reening programs to successfully identify individuals with cutaneous m alignancies. The significant association of noncompliance to seek reco mmended follow-up care with lack of health insurance for men too young to participate in Medicare suggests that approaches to definitive wor kup for uninsured patients be developed alongside free screening progr ams. (C) 1998 American Health Foundation and Academic Press.