title: A systematic review of advanced practice nurses' skin cancer assessment barriers, skin lesion recognition skills, and skin cancer training activities.
abstract: OBJECTIVE
  Little is known about the skin cancer detection skills of advanced practice nurses (APNs). This systematic review of published literature seeks to describe (a) barriers to APNs' performance of skin examination, (b) APNs' ability to recognize suspicious skin lesions, and (c) APNs' skin cancer detection training activities.
  
  
  METHODS
  The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the literature search (OVID Medline, Web of Science, and CINAHL databases) and interpretation of findings. Of the 136 articles meeting criteria for selection, 12 pertaining to the purpose were selected for further review.
  
  
  CONCLUSIONS
  Barriers to skin examination by APNs have been infrequently and inconsistently measured. Limited time to conduct skin examination is the most consistent barrier. APNs' ability to recognize and refer suspicious and benign lesions is inconsistent, but shows improvement after training. Few skin cancer training programs are available for APNs.
  
  
  CONCLUSIONS
  Larger and more rigorously designed studies are needed to better determine APNs' barriers and facilitators to skin cancer assessment and their ability to recognize and appropriately refer potentially malignant skin lesions with a high level of sensitivity and specificity. Training to increase these skills needs to be targeted to APNs and occur at a much higher volume than current efforts.
authors.affiliation: The University of Arizona, Tucson, 85721-0203, USA. loescher@nursing.arizona.edu
authors.forename: Lois J
authors.initials: LJ
authors.lastname: Loescher
authors.forename: John M
authors.initials: JM
authors.lastname: Harris
authors.forename: Clara
authors.initials: C
authors.lastname: Curiel-Lewandrowski
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D004509:Education, Nursing, Continuing; D004522:Educational Status; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009859:Oncology Nursing; D010808:Physical Examination; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000451:nursing