Is There Direct Evidence That Screening for Skin Cancers Leads to Reduced Morbidity and Mortality?
No data exists providing direct evidence that screening for skin cancer leads to reduced morbidity and mortality. No randomized trials or case-control studies of screening for skin cancer have been completed. Well-done, frequently cited observational studies of the relation between early detection and mortality have been done,88 but in such studies the effect of promoting primary prevention and self-examination cannot be distinguished from that of routine screening in patients seeing the physician for unrelated reasons.89 The lack of data reflects the lack of population-based programs that focus on routine total-body skin examination by a physician. The absence of randomized trials is also not surprising since melanoma is relatively rare in the general population. A recent review by Elwood90 examined the options for conducting a randomized trial of screening in detail. Elwood calculated that, to have a 90% chance of detecting a one-third reduction in mortality, a trial of screening wit
