title: A Large Skin Cancer Screening Quality Initiative: Description and First-Year Outcomes.
abstract: OBJECTIVE
  The lack of prospective randomized clinical trials demonstrating that full-body skin examination (FBSE) reduces melanoma morbidity or mortality has prompted an "I" rating from the United States Preventive Services Task Force for population-based skin cancer screening. More data on these screening programs are needed.
  
  
  OBJECTIVE
  To describe a skin cancer screening quality initiative in a large health care system and to determine if the intervention was associated with screening of a demographically higher-risk population than previous screening programs and if melanoma incidence and thickness differed in screened vs unscreened patients.
  
  
  METHODS
  This observational evaluation of a prospectively implemented quality initiative was conducted in a large health care system in western Pennsylvania (University of Pittsburgh Medical Center, UPMC) among adults seen in an office visit by a UPMC-employed primary care physician (PCP) in 2014.
  
  
  METHODS
  Implementation of a campaign promoting annual skin cancer screening by FBSE, including training of PCPs, promotion of the initiative to physicians and patients, and modification of the electronic health record (EHR) to include FBSE as a recommended preventive service for patients 35 years or older.
  
  
  METHODS
  Characteristics of screened and unscreened patients and melanomas detected among them.
  
  
  RESULTS
  Of 333 735 adult patients seen in an office visit by PCPs in 2014, 53 196 patients (15.9% of the screen-eligible population) received an FBSE, and 280 539 did not. Screened patients were slightly older (median age, 60 vs 57 years; P < .001) but did not differ significantly by sex (43.2% vs 43.1% men; P = .49) from the unscreened population. Fifty melanomas were diagnosed in screened patients and 104 melanomas were diagnosed in unscreened patients. Screened patients were more likely than unscreened patients to be diagnosed with melanoma (adjusted risk ratio [RR], 2.4; 95% CI, 1.7-3.4; P < .001) and to have a thinner invasive melanoma (median thickness, 0.37 mm vs 0.65 mm; P < .001). The incidence of melanoma lesions 1 mm or thicker was similar in screened vs unscreened patients (adjusted RR, 0.7; 95% CI, 02.-2.2; P = .52).
  
  
  CONCLUSIONS
  Large-scale screening for melanoma within a United States health care system is feasible and can result in increased detection of thinner melanomas. This intervention also resulted in screening of a higher proportion of men and an older patient population than previous screening interventions in which younger individuals and women predominated.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Ferris
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Melissa I
authors.initials: MI
authors.lastname: Saul
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Fei
authors.initials: F
authors.lastname: Ding
authors.affiliation: Providence VA Medical Center, Brown University, Providence, Rhode Island.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weinstock
authors.affiliation: Harvard Chan School of Public Health, Boston, Massachusetts.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.|Hofstra University School of Medicine, East Garden City, New York.
authors.forename: Erica
authors.initials: E
authors.lastname: Neuren
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.|Rutgers University School of Medicine, Newark, New Jersey.
authors.forename: Spandana
authors.initials: S
authors.lastname: Maddukuri
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Francis X
authors.initials: FX
authors.lastname: Solano
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Kirkwood
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D011320:Primary Health Care; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014481:United States