Barriers to effective skin cancer detection.
BACKGROUND
In response to the dramatic rise in melanoma incidence, numerous health care specialists have encouraged primary care providers to increase skin cancer detection efforts. Although primary care providers currently find more melanomas than do dermatologists, many detection opportunities are missed. In addition, primary care providers occasionally incorrectly reassure patients about specific lesions. Nevertheless, there is little evidence that efforts to detect skin cancer are growing. This paper discusses barriers to skin cancer detection and potential ways to increase screening.


METHODS
Methods involve the review of the medical literature and the author's synthesis of this information.


RESULTS
The principle barriers to skin cancer detection are that it is a low priority in primary care, that the majority of exams do not result in significant findings, and that many providers lack expertise to adequately identify high risk lesions. Lack of reimbursement for preventive care, inadequate time for complete skin exams, and distraction by other health problems also play a role in limiting skin cancer detection efforts.


CONCLUSIONS
Relying on primary care-based skin cancer detection as the only means to increase skin cancer identification is an unwise policy. Approaches that may be able to increase skin cancer prevention and detection include increased (1) collaboration between skin cancer specialists and experts in primary care, (2) focus on providers of pediatric care, (3) advocacy for reimbursement of preventive health care, (4) educational efforts for the public to request skin exams, and (5) education directed to providers in high risk areas.
Wender
R C
RC
Department of Family Medicine, Thomas Jefferson University, Philadelphia, PA 19107.
D002983:Clinical Competence; D003954:Diagnostic Services / Q000191:economics / Q000592:standards*; D006266:Health Education; D006292:Health Priorities; D006801:Humans; D007342:Insurance Benefits; D008545:Melanoma / Q000175:diagnosis*; D010808:Physical Examination / Q000191:economics / Q000592:standards; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards; D012878:Skin Neoplasms / Q000175:diagnosis*; D013997:Time Factors