title: A randomised trial of skin photography as an aid to screening skin lesions in older males.
abstract: OBJECTIVE
  We have previously shown that photographs assist in detection of change in skin lesions and designed the present randomised population based trial to assess the feasibility of photographs as an aid to management of skin cancers in older men.
  
  
  METHODS
  1899 men over fifty, identified from the electoral roll in two regions in New South Wales (NSW), Australia, were invited by mail to participate.
  
  
  METHODS
  A total of 973 of 1037 respondents were photographed and randomised into intervention (participants given their photographs) or control groups (photographs withheld by investigators). At one and two years from the time of photography, all participants were advised to see their primary care practitioner for a skin examination. Those in the intervention group were examined with their photographs and those in the control group without their photographs.
  
  
  RESULTS
  The results indicated that the practitioners were more likely to leave suspicious lesions in place for follow up observation (37% v 29%) (p=0.006) and less likely to excise benign non pigmented lesions (20 v 32%). There was little difference in excision rates for benign pigmented lesions (21% v 23%). Lesions excised were more likely to be non-melanoma skin cancer (58% v 42%) from patients who had photographs compared to those without photographs (p=0.005). The use of skin photography resulted in a substantial savings due to the reduced excision of benign lesions.
  
  
  CONCLUSIONS
  These results suggest that it would be feasible to conduct a large scale randomised trial to evaluate the value of photography in early detection of melanoma and that such a trial could be cost effective due to the reduced excision of benign skin lesions.
authors.affiliation: Oncology & Immunology Unit, Newcastle Mater Misericordiae Hospital, New South Wales, Australia.
authors.forename: P F
authors.initials: PF
authors.lastname: Hanrahan
authors.forename: C A
authors.initials: CA
authors.lastname: D'Este
authors.forename: S W
authors.initials: SW
authors.lastname: Menzies
authors.forename: T
authors.initials: T
authors.lastname: Plummer
authors.forename: P
authors.initials: P
authors.lastname: Hersey
mesh_terms: D001315:Australia; D003365:Costs and Cost Analysis; D005194:Family Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D015588:Observer Variation; D010358:Patient Participation; D010781:Photography / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000473:pathology* / Q000517:prevention & control / Q000628:therapy; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology