Effectiveness of interventions to support the early detection of skin-cancer through skin self-examination:a systematic review and meta-analysis

Summary (abstract) Background: As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self-examination (SSE), however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE-interventions. Objective: To systematically examine, map, appraise and synthesise, qualitatively and quantitatively, studies evaluating the early-detection of skin cancer, using SSE-interventions. Methods: Systematic review (narrative synthesis and meta-analysis) examining randomised controlled trials (RCTs), quasi-experimental, observational, qualitative studies, published in English, using PRISMA and NICE 1 guidance. Electronic databases: MEDLINE, EMBASE and PsycINFO, through to April 2015 (updated April 2018 using MEDLINE). Risk-of-bias assessment was conducted. Results: Included studies (n=18), totalling 6836 participants, were derived from 22 papers; these used 12 RCTs and 5 quasi-experiments (and 1 complex-intervention development). More studies (n=10) focused on those targeting high-risk groups (surveillance) compared to those at no higher risk (screening) (n=8). Ten (45%) study interventions were theoretically underpinned. All the study outcomes were self-reported, behaviour-related and non-clinical in nature. Meta-analysis demonstrated intervention impact on the degree of SSE activity from five studies, especially short-term (up to 4-months) (OR 2.31, 95% CI 1.90 to 2.82), but with small effect sizes. Limitation: Risk-of-bias assessment indicated that 61% (n=11) were of weak quality. Conclusions: Four RCTs and a quasi-experimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer, however, the actual clinical impact remains unclear and this is based on overall weak study (evidence) quality.