A systematic review and synthesis of qualitative and quantitative studies evaluating provider, patient, and health care system-related barriers to diagnostic skin cancer examinations

Melanoma-screening examinations support early diagnosis, yet in America there is a national shortage of dermatologists and most at-risk patients lack access to dermatologic care. Primary care physicians (PCPs) often bridge these access gaps and play a critical role in the early detection of melanoma. Despite this, most PCPs do not offer skin examinations. A systematic review to identify barriers for skin screening was conducted. 48 studies met the inclusion criteria. The most common barriers reported by PCPs included lack of dermatologic training (89.4%), time constraints (70%), and competing comorbidities (51%). Low perceived risk (69%), long delays in appointment (46%), and lack of knowledge about melanoma (34.8%) were the most frequently reported patient barriers. Barriers for health system included lack of public awareness, social prejudice leading to tanning booth usage, public surveillance programs requiring intensive resources, and delays in seeking medical attention for melanomas. Numerous barriers remain that prevent the implementation of skin screening practices in clinical practice. A multi-faceted combination of efforts is essential for the execution of acceptable and effective skin cancer-screening practices to increase early diagnosis and reduce mortality rates and burden of disease for melanoma.

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