You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Detection of artificial changes in mole size by skin self-examination.
Abstract 1:
BACKGROUND The efficacy of the skin self-examination ( SSE ) to detect artificial changes in the size of nevi has not been evaluated in a controlled setting . OBJECTIVE Our purpose was to determine the sensitivity and specificity of the SSE  in detecting artificial changes in mole size in patients at high risk for melanoma . METHODS In a single-center , single-blinded cross-over study , patients who had been performing the SSE confidently for at least 1 year examined their backs after the diameter of an existing mole was increased artificially in r and om order by 0 , 2 , or 4 mm . RESULTS The specificity of the SSE  was 62 % ( 95 % confidence interval [ CI ] , 53%-72 % ) ( N = 103 ) . The sensitivity of the 2 mm change was 58 % ( 95 % CI , 49%-68 % ) and that of the 4 mm change was 75 % ( 95 % CI , 66%-83 % ) .  SSE performance was not related to perceived risk , number of moles , gender , age , or frequency of self-examination . CONCLUSION Even in our highly motivated and selected group of high-risk patients , 25 % could not detect an obvious increase in the diameter of an existing nevus , whereas 38 % incorrectly identified a change when none was made . The SSE is only a moderately effective tool for the detection of acute , large , changes in mole size . The usefulness of the SSE in detection of new lesions or changes in existing lesions is likely due to a combination of factors or due to factors other than size , such as color , border irregularity , and texture , among others


Title 2:
Diagnostic accuracy of patients in performing skin self-examination and the impact of photography.
Abstract 2:
OBJECTIVE To determine the sensitivity and specificity of skin self-examination ( SSE ) to detect new and changing moles with and without the aid of baseline digital photographs in patients with dysplastic nevi . DESIGN AND INTERVENTION Patients had baseline digital photography and mole counts of their back , chest , and abdomen and were instructed to perform a baseline SSE . Print copies of the images were provided to the patient . Following the baseline examination , the appearance of existing moles was altered and new moles were created using cosmetic eyeliner . The number of moles altered and /or created totaled approximately 10 % of each patients ' absolute mole count . SETTING AND PATIENTS Fifty patients with 5 or more dysplastic nevi from the outpatient clinic at Memorial Sloan-Kettering Cancer Center , New York , NY . MAIN OUTCOME MEASURE  Skin self-examinations with and without access to the baseline photographs to identify the number of new and altered moles . RESULTS The sensitivity and specificity of SSE  for detection of both altered and new moles without photography were 60.2 % and 96.2 % , respectively . Skin self-examination  with photography yielded a sensitivity and specificity of 72.4 % and 98.4 % , respectively . The findings were similar when stratified by site ( back vs chest or abdomen ) . The sensitivity and specificity for new moles were higher compared with altered moles . CONCLUSIONS Access to baseline photography improved the diagnostic accuracy of SSE on the back and chest or abdomen and improved detection of changing and new moles . Our results suggest that baseline digital photography in t and em with SSE may be effective in improving the diagnostic accuracy of patients performing SSE


Title 3:
A randomised trial of population screening for melanoma
Abstract 3:
Objectives : Melanoma is a significant cause of morbidity and mortality worldwide and incidence is increasing . Survival after treatment is inversely related to the thickness of the tumour at diagnosis . Population screening has the potential to reduce mortality but there is no conclusive evidence of benefit . Such evidence can come best from a r and omised trial . Here we describe the design of a community based r and omised trial of a  population screening programme for melanoma in Queensl and , Australia and early results of the first phase of the trial . Methods : A total of 44 communities ( aggregate population 560 000 adults aged 30 years or more ) will be r and omised to receive either a community based screening programme for 3 years or normal practice . The screening programme promotes thorough skin self examination and whole body skin examination by a doctor and provides open access skin cancer screening clinics . In its first phase , the trial is underway in nine intervention and nine control communities . The primary outcome measure is mortality from melanoma during 15 years of follow up . Results : The first phase of the trial has shown the feasibility of implementing a population skin screening programme including regular skin cancer screening clinics , and has shown the strong support of communities and doctors for the programme . There has been a significant 2.5-fold increase in participation in screening in the intervention communities in this first phase after the first 12 months of the trial and no significant increase in participation in screening in control communities during this period . Conclusions : The design of a community based r and omised trial of screening for melanoma has been successfully peer review ed and the intervention has been shown to be feasible in practice . This r and omised trial may be one of the last opportunities to develop the evidence required for public health recommendations for population screening for melanoma


Title 4:

Early Detection of Skin Cancer by Family Physicians: A Pilot Project

Abstract 4:
Background : Malignant melanoma is rising quickly in incidence and mortality rates . Family physicians ( FPs ) have been reported to lack confidence in diagnosing skin cancers . Objective : The aim of this study was to determine whether an educational intervention can improve FPs ’ abilities to diagnose skin cancers . Methods : The design was a prospect i ve , r and omized trial which included a skin cancer question naire , a video intervention , and a skin biopsy review . Results : Pre-intervention , FPs answered 57 % of the questions correctly on the skin cancer question naire . Post-intervention , the video intervention group scored higher than did the control group . The video intervention group removed 10 % fewer benign lesions and almost 3 times more malignant lesions compared with their pre-intervention biopsy rate . No findings were statistically significant . Conclusion : An educational intervention may improve  FPs ’ knowledge and diagnosis of skin cancer . Our results may guide future studies with larger sample sizes in developing a skin cancer continuing medical education ( CME ) course for FPs . Antécédents : L’incidence des mélanomes et le taux de mortalité qui y est associé augmentent rapidement , ce qui laisse suggérer que les médecins de famille n’ont pas la confiance nécessaire pour diagnostiquer le cancer de la peau . Objectif : Déterminer si une campagne d’éducation peut améliorer la capacité des médecins de famille à diagnostiquer les cancers de la peau . Méthodes : Une étude prospect i ve r and omisée a été menée , comprenant un question naire sur le cancer de la peau , une séance éducative sur vidéo et un aperçu d’une biopsie de la peau . Résultats : Avant la séance , les médecins de famille ont obtenu de bonnes réponses à 57 % des questions figurant sur le question naire du cancer de la peau . Le groupe qui a assisté à la séance vidéo a eu un meilleur résultat que le groupe précédent . Le groupe a enlevé 10 % de moins de tumeurs bénignes et 3 fois plus de tumeurs malignes après l’aperçu de la biopsie . Toutefois , ces résultats ne représentent pas des statistiques significatives . Conclusion : Des mesures éducatives pourront améliorer les connaissances des médecins de famille et leurs capacités de diagnostiquer les mélanomes . Nos résultats pourront orienter de futures études , avec un plus large nombre de participants , dans la mise au point d’une stratégie d’éducation médicale continue ( EMC ) sur le cancer de la peau , destinée aux médecins de famille
Results Key Question Does screening in asymptomatic persons with whole-body examination by a primary care clinician or by self-examination  reduce morbidity and mortality from skin cancer ?
We found no new evidence on the effectiveness of skin examination by a physician in reducing the morbidity or mortality of skin cancer .
Context ual Question 1 Can screening with whole-body examination by primary care clinicians or by self-examination accurately detect skin cancers ?