Clinical utility of skin cancer and melanoma risk scores for population screening: TRoPICS study.

BACKGROUND Screening for skin cancer can be cost-effective if focused on high-risk groups. Risk prediction tools have been developed for keratinocyte cancers and melanoma to optimise advice and management. However, few have been validated in a clinical setting over the past few years. OBJECTIVES To assess the clinical utility of risk-assessment tools to identify individuals with prevalent skin cancers in a volunteer-based screening clinic. METHODS Participants were adults presenting for a skin check at a volunteer-based skin cancer screening facility. We used previously published tools, based on questionnaire responses, to predict melanoma and keratinocyte cancers (KC) [basal (BCC) and squamous cell carcinomas (SCC)] and classified each participant into one of 5 risk categories. Participants subsequently underwent a full skin examination by a dermatologist. All suspicious lesions were biopsied and all cancers histopathologically confirmed. RESULTS Of 789 people who presented to the clinic, 507 (64%) consented to the study. Twenty-two BCCs, 19 SCCs and 8 melanomas were diagnosed. The proportion of keratinocyte cancers diagnosed increased according to risk category from less than 1% in the lowest to 24% in the highest risk category (p<0.001). Subtype analysis revealed similar proportionate increases in BCC or SCC prevalence according to risk category. However, a similar proportion of melanoma cases were detected in the low-risk and high-risk groups. CONCLUSION The risk prediction model for keratinocyte cancers can reliably identify individuals with a significant skin cancer burden prior to a skin examination in the community setting. The prediction tool for melanoma needs to be tested in a larger sample exposed to a wider range of environmental risk factors.