title: Downstream consequences of melanoma screening in a community practice setting: First results.
abstract: BACKGROUND
  Population-based screening for the early detection of melanoma holds great promise for reducing melanoma mortality, but evidence is needed to determine whether benefits outweigh risks. Skin surgeries and dermatology visits after screening were assessed to indicate potential physical, psychological, and financial consequences.
  
  
  METHODS
  Targeted primary care providers (PCPs) at the University of Pittsburgh Medical Center were trained to detect early melanoma using the INFORMED (INternet course FOR Melanoma Early Detection) program. The authors analyzed aggregated administrative data describing 3 groups of patients aged ≥35 years who had received an annual physical examination by PCPs: group A1 included patients of PCPs from the group with the highest percentage of INFORMED-trained providers, group A2 included patients of PCPs from the group with a lower percentage of INFORMED-trained providers, and group B included patients of PCPs without INFORMED training.
  
  
  RESULTS
  INFORMED-trained PCPs screened 1572 of 16,472 patients in groups A1 or A2 and none of the 56,261 patients in group B. In group A1, there was a 79% increase (95% confidence interval, 15%-138%) in melanoma diagnoses noted; no increase was observed for the other groups, and no substantial increase in skin surgeries or dermatology visits occurred in any group.
  
  
  CONCLUSIONS
  A large-scale melanoma screening using the INFORMED program was conducted in Pennsylvania. To the best of the authors' knowledge, the current study is the first analysis of downstream results and the findings indicate increased melanoma diagnoses but little impact on skin surgeries or dermatology visits. This result provides some reassurance that such efforts can be conducted without major adverse consequences, at least as measured by these parameters, and therefore should be considered for more widespread use. Cancer 2016;122:3152-6. © 2016 American Cancer Society.
authors.affiliation: Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island. maw@brown.edu.|Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island. maw@brown.edu.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weinstock
authors.affiliation: Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Ferris
authors.affiliation: Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Melissa I
authors.initials: MI
authors.lastname: Saul
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
authors.affiliation: Department of Epidemiology, Brown University, Providence, Rhode Island.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Risica
authors.affiliation: Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Siegel
authors.affiliation: Physician Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Solano
authors.affiliation: Melanoma and Skin Cancer Program, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Kirkwood
mesh_terms: D000328:Adult; D003153:Community Health Services; D003695:Delivery of Health Care; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D009367:Neoplasm Staging; D058007:Physicians, Primary Care / Q000193:education*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011379:Prognosis; D012878:Skin Neoplasms / Q000175:diagnosis*
keywords: dermatologic surgical procedures; mass screening; melanoma; mortality; office visits