title: Effectiveness of skin cancer screening for individuals age 14 to 34 years.
abstract: BACKGROUND
  Approximately 15 % of all cases of melanoma are diagnosed before age 35 years. In Germany, individuals ≥ 35 years are eligible for the national skin cancer screening program. The effectiveness of a population-based skin cancer screening in general and in particular for young adults is unclear.
  
  
  OBJECTIVE
  Assessment of the effectiveness of a skin cancer screening program and of risk factors for detection of a melanoma/atypical nevus in the setting of a screening for the age group 14 to 34 years.
  
  
  METHODS
  A total of 12,187 individuals age 14 to 34 years were screened in Saxony for skin cancer by a dermatologist in the program "Haut-Check 14-34 Jahre" of the AOK PLUS, a large German health insurance, between January and July 2009. Demographic, clinical and histopathological data and UV-exposure data were collected from each participant. Multivariate logistic regression models were used to assess risk factors for the detection of a (histopathologically confirmed) melanoma or atypical nevus.
  
  
  RESULTS
  2.8 % of the eligible individuals participated in the skin cancer screening program with women being more likely to do so. In 1 072 individuals (8.8 %) screening included at least one excision of a skin lesion leading to the diagnosis of melanoma in two participants, melanoma in situ in four persons, and atypical nevus in 641 persons. Use of tanning beds, higher age, number of nevi, and previous cutaneous excision were independent risk factors for the detection of a melanoma or atypical nevus.
  
  
  CONCLUSIONS
  In 5.5 % of all cases skin cancer screening resulted in the excision of a malignant or atypical melanocytic lesion. It remains unclear what proportion of these cases would have been detected in routine care. The rate of excisions per newly diagnosed melanoma was 179 : 1. Further investigations are necessary to explore the reasons for this low diagnostic specificity. This study highlights the possibilities and limitations of routine data to evaluate screening programs and indicates the need to collect additional information on healthcare utilization behaviour.
authors.affiliation: Department of Dermatology, University Clinic Carl Gustav Carus, Technical University Dresden, Germany. jochen.schmitt@uniklinikum-dresden.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.forename: Andreas
authors.initials: A
authors.lastname: Seidler
authors.forename: Georg
authors.initials: G
authors.lastname: Heinisch
authors.forename: Günther
authors.initials: G
authors.lastname: Sebastian
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D009313:National Health Programs / Q000191:economics; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D009508:Nevus, Pigmented / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D015397:Program Evaluation; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D014466:Ultraviolet Rays / Q000009:adverse effects; D055815:Young Adult