title: Total-Body Examination vs Lesion-Directed Skin Cancer Screening.
abstract: OBJECTIVE
  Skin cancer is the most frequent cancer type. It remains unknown if and how screening programs can be organized in a cost-effective manner.
  
  
  OBJECTIVE
  To compare the 2 screening strategies of systematic total-body examination (TBE) and lesion-directed screening (LDS), with a focus on the participation rate, detection rate, anxiety, and cost.
  
  
  METHODS
  Population-based cross-sectional screenings by a team of 6 dermatologists were organized in 2 sociodemographically similar regions. The TBE was organized in a community of 9325 inhabitants 18 years and older (Wichelen, East Flanders, Belgium) during a 5-day screening (March 14-18, 2014). The LDS was organized in a sociodemographically comparable community (Nevele, East Flanders, Belgium) of 9484 adult inhabitants during a 4-day screening (April 22 and 25-27, 2014). The first population received a personal invitation for a standard TBE. In the second population, individuals were invited for an LDS if they had a lesion meeting 1 or more of the following criteria: ABCD rule (A, asymmetry; B, borders; C, colors; and D, differential structures), ugly duckling sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions.
  
  
  METHODS
  In total, 1982 individuals were screened, and 47 skin cancers (2.4%) were histologically confirmed, including 9 melanomas (0.5%), 37 basal cell carcinomas (1.9%), and 1 squamous cell carcinoma or Bowen disease (0.1%).
  
  
  RESULTS
  The positive predictive value for all suspicious lesions was 56.6% (47 of 83). The participation rate was 17.9% (1668 of 9325) in the TBE group vs 3.3% (314 of 9484) in the LDS group (P < .01). The skin cancer detection rate per 100 participants did not differ significantly between the 2 groups, with rates of 2.3% (39 of 1668) in the TBE group vs 3.2% (8 of 248) in the LDS group (P = .40). The operational effectiveness per 100 invitees was 0.4% (39 of 9325) in the TBE group vs 0.1% (8 of 9484) in the LDS group (P < .01). In addition, LDS was 5.6 times less time consuming than TBE. Participants in the LDS group had significantly higher baseline anxiety levels compared with participants in the TBE group (3.7 vs 3.3 points on a visual analog scale, P < .01). In screenees without a suspicious lesion, anxiety levels significantly dropped after screening.
  
  
  CONCLUSIONS
  Total-body examination yielded a higher absolute number of skin cancers. Lesion-directed screening had a similar detection rate of 3.2% (8 of 248) but was 5.6 times less time consuming. When performed by dermatologists, LDS is an acceptable alternative screening method in health care systems with limited budgets or long waiting lists.
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Hoorens
authors.affiliation: private practice, Maldegem, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Vossaert
authors.affiliation: Department of Public Health, University Ghent, Ghent, Belgium.
authors.forename: Lore
authors.initials: L
authors.lastname: Pil
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Boone
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: De Schepper
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Katia
authors.initials: K
authors.lastname: Ongenae
authors.affiliation: Department of Public Health, University Ghent, Ghent, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Ines
authors.initials: I
authors.lastname: Chevolet
authors.affiliation: Department of Dermatology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Brochez
mesh_terms: D000328:Adult; D000368:Aged; D001530:Belgium; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D008875:Middle Aged; D010808:Physical Examination / Q000191:economics / Q000379:methods*; D011237:Predictive Value of Tests; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology