Screening for cutaneous malignant melanoma: a feasibility study.
OBJECTIVE
To study two different procedures for inviting subjects to screening for malignant melanoma, and to study the role of specially trained nurses as primary examiners.


METHODS
The study was carried out in Stockholm county and comprised 5000 randomly selected men and women aged 40 to 60, of whom 2,500 were invited with a personal invitation letter and with a set time of appointment and 2,500 were sent a questionnaire and instructions for self examination of the skin. To test the nurses' competence, a survey was made, comparing the judgments of skin examination between nurses and doctors.


RESULTS
1654 (66%) of those invited for a skin examination took part. 1507 (60%) replied in the questionnaire group, of whom 1024 (41%) requested and attended a subsequent skin examination. Of the subjects attending from both groups, the nurses judged 9% v 11% as having skin lesions suggesting malignant melanoma, whereas the two doctors referred 4% v 3% of the subjects for surgical biopsy. Two malignant melanomas were detected, both of them in the questionnaire group. In the study of nurses' screening competence, both nurses and doctors equally judged one case out of 19 as having a lesion suspicious for malignant melanoma.


CONCLUSIONS
When the questionnaire method was used the results were achieved with one third fewer skin examinations, but it is difficult to conclude whether one of the procedures is better than the other. The results also indicate that nurses can be trained to be the primary examiners in a melanoma screening programme.
Törnberg
S
S
Department of General Oncology, Radiumhemmet, Karolinska Hospital, Stockholm, Sweden.
Månsson-Brahme
E
E
Lindén
D
D
Ringborg
U
U
Krakau
I
I
Kärnell
R
R
Landegren
J
J
Brandberg
Y
Y
Hakulinen
T
T
D000328:Adult; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008545:Melanoma / Q000453:epidemiology*; D008875:Middle Aged; D009726:Nurses; D010808:Physical Examination; D010820:Physicians; D015397:Program Evaluation; D016353:Self-Examination; D012878:Skin Neoplasms / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology