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      Screening for Skin Cancer: A Pilot Study in Tehran, Iran

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          Abstract

          Background:

          Early detection of skin cancers by screening could be very beneficial to decrease their morbidity or mortality. There is limited study about skin cancer screening in Iran.

          Aim:

          This essay was planned as a pilot skin cancer screening campaign in Tehran, Iran to evaluate its profit and failure and further design large-scale screening program more definitely.

          Materials and Methods:

          Thirty one public health centers of Shahid Beheshti Medical University were selected in different areas of Tehran. The project was announced via media and invited all the people above 40 years old to come for the whole-body skin examination in a one-week period. Patients with any suspected lesions were referred to the dermatology clinics of the university.

          Results:

          1314 patients, 194 males (14.8%) and 120 females (85.2%), with mean age of 51.81 ± 10.28 years participated in this screening campaign. Physicians found suspected lesions in 182 (13.85%) of participants. The diagnosis of skin cancer was confirmed in 15 (1.14%) patients. These malignancies included 10 (0.76%) cases of basal cell carcinoma, 2 (0.15%) cases of squamous cell carcinoma and 3 (0.23%) cases of malignant melanoma.

          Conclusion:

          Skin cancer screening seems to be valuable to detect skin malignancies in their early course. Regarding the considerable amount of facilities needed to perform skin cancer screening program, it might be more beneficial to perform the targeted screening programs for the high-risk groups or emphasis more on public education of skin cancer risk factors and their early signs.

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          Most cited references 20

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          Clinical whole-body skin examination reduces the incidence of thick melanomas.

          Survival from melanoma is strongly related to tumour thickness, thus earlier diagnosis has the potential to reduce mortality from this disease. However, in the absence of conclusive evidence that clinical skin examination reduces mortality, evidence-based assessments do not recommend population screening. We aimed to assess whether clinical whole-body skin examination is associated with a reduced incidence of thick melanoma and also whether screening is associated with an increased incidence of thin lesions (possible overdiagnosis). We conducted a population-based case-control study of all Queensland residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 eligible cases (78.0%) and 3,824 eligible controls (50.4%). Whole-body clinical skin examination in the three years before diagnosis was associated with a 14% lower risk of being diagnosed with a thick melanoma (>0.75 mm) (OR = 0.86, 95% CI = 0.75, 0.98). Risk decreased for melanomas of increasing thickness: the risk of being diagnosed with a melanoma 0.76-1.49 mm was reduced by 7% (OR = 0.93, 95% CI 0.79, 1.10), by 17% for melanomas 1.50-2.99 mm (OR = 0.83, 95% CI = 0.65, 1.05) and by 40% for melanomas > or =3 mm (OR = 0.60, 95% CI = 0.43, 0.83). Screening was associated with a 38% higher risk of being diagnosed with a thin invasive melanoma (< or =0.75 mm) (OR = 1.38, 95% CI = 1.22, 1.56). This is the strongest evidence to date that whole-body clinical skin examination reduces the incidence of thick melanoma. Because survival from melanoma is strongly related to tumour thickness, these results suggest that screening would reduce melanoma mortality.
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            Cancer in East Azerbaijan, Iran: results of a population-based cancer registry.

            Regardless of the fact that cancers of GI tract have been reported to be the most common fatal neoplasms in East Azerbaijan, there is a serious lack of population-based studies in this region. A comprehensive search was therefore undertaken to prospectively register all cases of cancer occurring in the province during March 2006-2007. Diagnosis of cancer was based on histopathology of primary lesions in 84.0% of cases, clinical investigation and ultrasound in 7.2%, only clinical investigation in 5.4%, and histology of metastasis in 2.9. Less than 1% were based on cytology and death certificates in one official year. A total of 4,922 cancers (mean age 60.2+18.13 years) were diagnosed during this population-based study. Of these, 56.8% (2114) were in males. ASRs for all cancers in males and females were 164.3 and 130.6 respectively. The top five sites for cancer in males (excluding skin cancer) according to the calculated ASR (world) were stomach (26.0), bladder (15.7), esophagus (12.4), colon and rectum (11.6) and blood (10.8); in females, they were breast (23.5), esophagus (11.7), stomach (11.6), colon and rectum (9.7) and nervous system (5.5). This first comprehensive report on cancer incidence in East Azerbaijan, documents particularly high incidence rates for esophageal and gastric cancer across the sexes.
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              Screening for skin cancer: U.S. Preventive Services Task Force recommendation statement.

                (2009)
              Update of the 2001 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for skin cancer. To update its recommendation, the USPSTF reviewed evidence published since 2001 on studies on screening effectiveness, the stage of detection by screening, and the accuracy of whole-body examination by primary care clinicians and self-examination by patients. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for skin cancer by primary care clinicians or by patient skin self-examination. (I statement).
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                Author and article information

                Affiliations
                From Skin Research Center, Department of Dermatology, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Tehran, Iran
                Author notes
                Address for correspondence: Dr. Reza M. Robati, Skin Research Center, Shahid Beheshti University of Medical Sciences, Shohada-e Tajrish Hospital, Shahrdari St, Tehran, Iran. E-mail: rezarobati@123456sbmu.ac.ir
                Journal
                Indian J Dermatol
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications & Media Pvt Ltd (India)
                0019-5154
                1998-3611
                Jan-Feb 2014
                : 59
                : 1
                : 105
                3884910
                IJD-59-105a
                10.4103/0019-5154.123534
                Copyright: © Indian Journal of Dermatology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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