Literature Search Strategy
Literature searching was conducted in three stages.
Stage 1: Clinical Practice Guidelines
For the first stage, the following Web sites were searched in February 2003 and August 2006 to locate existing practice guidelines published in English: Guideline Advisory Committee (http://gacguidelines.ca/), Canadian Medial Association Infobase of Clinical Practice Guidelines (http://mdm.ca/cpgsnew/cpgs/), National Guideline Clearinghouse (http://www.guideline.gov/), MEDLINE (Ovid, 1996-August 2006), National Comprehensive Cancer Network (http://www.nccn.org/), National Institute for Clinical Excellence (http://www.nice.org.uk/), American Society of Clinical Oncology (http://www.asco.org/), Scottish Intercollegiate Guidelines Network (http://www.sign.ac.uk/), Canadian Dermatology Association (http://www.dermatology.ca/), and the American Academy of Dermatology (http://www.aad.org/). The text of each guideline report was scanned for references to other guidelines.
Stage 2: Primary Evidence on Screening for Skin Cancer
The second stage was a search for systematic reviews and studies of skin cancer screening published between 1999 and August 2006. This search was conducted to find evidence published after the completion of the most recent evidence-based screening guideline found by the search above. Sources searched included MEDLINE (Ovid), EMBASE (Ovid), and the Cochrane Library (2006, Issue 3). Separate searches were conducted for systematic reviews and primary studies (clinical trials, prospective cohort studies, or case-control studies). Individual search strategies were devised for each database, using text words and subject headings such as "skin neoplasms," "skin," "cancer," "carcinoma," "squamous," "basal," "melanoma," "mass screening," physical examination," and "skin examination".
Stage 3: Risk Factors for Skin Cancer
MEDLINE, EMBASE, and personal files were searched for recent reviews and key studies on risk factors for skin cancer.
Study Selection Criteria
Inclusion Criteria
Clinical Practice Guidelines
To be considered for inclusion as evidence-based clinical practice guidelines, guideline reports were required to:
- Contain explicit recommendations about screening for skin cancer with total body skin examination or skin self-examination
- Document a systematic review of the literature
- List references for the evidence considered
Primary Evidence on Screening for Skin Cancer
Studies were eligible for the evidence review if they:
- Were clinical trials with an intervention and control group (randomized or non-randomized), comparative cohort studies, or case-control studies
- Evaluated screening using total body skin examination or skin self-examination
- Included members of the general population or individuals at increased risk of skin cancer
- Screened for melanoma, basal cell carcinoma, or squamous cell carcinoma of the skin
Ideally, guideline recommendations would be based on evidence from randomized controlled trials. In the absence of randomized trials, other types of comparative studies were included. For screening manoeuvres without evidence from comparative studies, prospective single-cohort studies were considered.
Risk Factors for Skin Cancer
A comprehensive systematic review of the evidence on risk factors for skin cancer was beyond the scope of this guideline report. Instead, the panel summarized quantitative evidence available from published reviews and key primary studies.
Exclusion Criteria
- Abstracts, letters, and editorials were not eligible for inclusion in the systematic review of the evidence.
- Literature searches for primary studies on screening were not restricted by language, but searches for guidelines and information about risk factors were restricted to papers published in English.