Defining the Validity of Skin Self-Examination as a Screening Test for the Detection of Suspicious Pigmented Lesions: A Meta-Analysis of Diagnostic Test Accuracy.

BACKGROUND: Skin self-examination (SSE) is widely promoted for the detection of suspicious pigmented lesions. However, determining screening accuracy is essential to appraising the usefulness of SSE. OBJECTIVES: The aim of this work was to pool estimates from studies of SSE diagnostic accuracy in the detection of suspicious pigmented lesions. METHODS: This study was registered with PROSPERO (CRD42021246356) and conducted in accordance with PRISMA-DTA guidelines. A systematic search of Medline (PubMed) EMBASE, CINAHL, and The Cochrane Library was conducted to identify relevant studies. We included studies that examined the accuracy of SSE, either whole-body or site-specific, for detecting change in individual pigmented lesions or detecting an atypical naevus. A univariate random-effects model, based on logit-transformed data, was used to calculate a summary diagnostic odds ratio (DOR) as well as pooled sensitivity and specificity. Cochran's Q test and the I2 statistic were calculated to assess heterogeneity. A proportional hazards model was used to calculate the area under the curve (AUC) and plot the summary receiver operator characteristic curve. We used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to grade study quality. RESULTS: We identified 757 studies, of which 3 met inclusion criteria for quantitative synthesis. The pooled sensitivity and specificity based on 553 included participants was 59 and 82%, respectively. The summary DOR was 5.88 and the AUC was 0.71. There were some concerns regarding risk of bias in all 3 studies. CONCLUSIONS: SSE can detect suspicious pigmented lesions with reasonable sensitivity and relatively high specificity, with the AUC suggesting acceptable discriminatory ability.

National survey of patch testing in the United Kingdom and Republic of Ireland: what proportion of the population is and should be tested?

BACKGROUND: An initial study of patch testing practices across Wales, United Kingdom, showed wide variation in practice against a standardized set of guidelines and best practice recommendations. OBJECTIVES: To evaluate (i) current patch testing practice on a national level in the United Kingdom and Republic of Ireland (ROI), (ii) compliance with the current published guidelines, and (iii) the proportion of the catchment population tested by patch testing centres. METHODS: In consultation with the British Association of Dermatologists and British Society for Cutaneous Allergy, proformas addressing clinical guidelines and best practice recommendations were sent to all dermatology units in the United Kingdom and ROI. RESULTS: Ninety one of 325 centres (28%) performed patch testing. The optimum proportion of annual tests was not being achieved in the United Kingdom and ROI. The range tested varied between 1:1200 and 1:1600. CONCLUSIONS: Most centres achieved a high level of best practice outcomes. Shortcomings were found in the recording of minimum data, benchmarking, and attendance at meetings. We suggest that the findings of this study should be used as evidence to help improve services locally.