Prevention

 

 

In July 2008 a skin cancer mass screening programme was introduced in Germany. The programme has led to much controversy. The following study analyses the current situation. You may read the summary on this page. The complete study is available for a download.

 

 

The skin cancer screening experiment in Germany

Summary

Background: Germany is the first and until today the only country that introduced a national skin cancer screening programme in July 2008. Men and women above 35 years of age are eligible to participate in the programme every two years. The examination of the skin is performed either by a general practitioner or by a dermatologist.

Methods: The introduction and implementation period of the programme is evaluated. The diagnostic method (= screening test) used in the programme is the „visual inspection of the skin by naked eye”. The diagnostic accuracy of this method is known and is applied to the diagnosis of cutaneous malignant melanoma.

Methods: The introduction and implementation period of the programme is evaluated. The diagnostic method (= screening test) used in the programme is the „visual inspection of the skin by naked eye”. The diagnostic accuracy of this method is known and is applied to the diagnosis of cutaneous malignant melanoma.

Results: The skin cancer screening programme in Germany was introduced without any scientific justification. The analysis of the diagnostic accuracy shows that participating physicians in the screening programme will diagnose suspicious skin lesions in nearly every fifth patient by applying visual inspection of the skin by naked eye. Clinically suspect lesions must be surgically removed. In the screening programme 1,728 surgeries of suspect lesions must be carried out to find one cutaneous malignant melanoma confirmed by histology. A considerable number of dermatologists reject the screening programme due to the low specificity of the visual inspection by naked eye. Many dermatologists perform the visual screening only by means of dermoscopy to improve the diagnostic accuracy.

Consequences: The national skin cancer screening programme in Germany is not standardised. It is carried out with unclear aims, unclear diagnostic methods and unclear access. The visual inspection of the skin by naked eye is not an appropriate screening test for a melanoma mass screening. A reasonable scientific evaluation of the programme is currently not possible. An improvement of the skin cancer screening in Germany is absolutely essential.