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Prevalence and predictors of skin self‐examination: prospects for melanoma prevention and early detection

The benefits of routine screening for melanoma have not been established. Although the overall goal of screening for melanoma is earlier detection and decreased mortality, there have been no randomized controlled trials demonstrating that screening does indeed reduce mortality from melanoma. Such trials are unlikely to be performed because of the relative rarity of melanoma in most populations, requiring a large sample size and prolonged follow-up. The effect of skin self-examination (SSE) on melanoma incidence and stage at presentation was examined in a landmark case–control study by Berwick et al ., 1 who found that SSE may decrease mortality from melanoma by 63%. In contrast with routine clinical skin examination and specialized melanoma screening programs (in Italy, Australia, and Scotland, it has been shown that both increased proportions of thinner tumors and a decrease in melanoma mortality rates have followed broad public health campaigns 2–6 aimed at increasing screening behavior among the general population), SSE is conducted with unknown prevalence, accuracy, and outcome. Reflecting this uncertainty are conflicting guidelines for melanoma screening. Both the American Cancer Society and the National Institutes of Health recommend routine screening for skin cancer, and promote SSE for all individuals beginning at 20 years of age. 7,8 By contrast, the United States Preventive Services Task Force and the Canadian Task Force on Preventive Health Care neither recommend nor are against routine screening of the general population for skin cancer, citing a lack of sufficient evidence. 9,10 Like other screening approaches, SSE has potential adverse effects, such as an increased number of skin surgical procedures for benign lesions with their accompanying costs, as well as the psychologic impact of a possible diagnosis of melanoma. Thus, it is unclear whether the benefits of SSE outweigh the risks. A formal study of the potential impact of SSE on melanoma incidence and mortality is unlikely to be forthcoming in the short term; therefore, it is important to understand the prevalence and predictors of SSE in general populations in the meantime. In this article, we provide a review of the current knowledge of the prevalence of SSE in general and special populations, summarize what is known about individuals’ success in adopting SSE, and comment on the scarce literature linking SSE to melanoma outcomes (decrease in incidence and mortality).