Public health engagement: detection of suspicious skin lesions, screening and referral behaviour of UK based chiropractors

Malignant melanoma incidence rates have increased more than fivefold since the mid-1970s and continue to rise [1]. In 2002, the UK paid over £240 million in total costs associated with skin cancer; of which 42% were direct costs to the NHS [2]. Of the various forms of skin cancer, melanoma treatment was directly responsible for 63% of this total. Early detection of pre-cancerous and cancerous lesions not only improves patient mortality rates [3-5] it also substantially reduces this economic burden by enabling faster, cheaper and less-invasive interventions as out-patients in comparison to the otherwise high costs associated with in-patient care required to treat advanced lesions. Yet, in a study of US patients, 75% reported having never been advised by their medical practitioner or any other medical professional in their medical practice, to examine their skin for growths or changes in spots or moles. Furthermore, most participants (58% and 83% respectively) reported that their medical practitioner ‘never’ or ‘rarely’ looked at the skin on their back or on the backs of their legs [6].

However, in the UK, in addition to medical practitioners, a diverse group of clinical practitioners are in a position to detect, screen and refer suspicious skin lesions [6-10]. Of these, a smaller number regularly see patients unclothed and particularly see areas of the body inaccessible to visual inspection by the patient themselves. Of those that do, manual therapists such as masseurs, osteopaths and chiropractors are ideally placed to regularly screen the skin for suspicious lesions. Chiropractic practice is concerned with the diagnosis and treatment of musculoskeletal syndromes, including low back, neck pain, headaches and peripheral joint problems [11]. Despite 42% of chiropractors regularly examining patients who were in their underwear [12], little if any research exists that has attempted to determine whether chiropractors in the field take advantage of this opportunity to perform basic skin screening. Of that research already carried out, this was restricted to a student population only and recommended that further research should test the ability of chiropractors to identify pathological moles on a broader, evaluative basis [13]. In view of this we investigated the accuracy with which chiropractic student clinicians and registered chiropractors were able to recognise as suspicious or benign, a variety of common skin lesions from images chosen by a dermatologist. More generally we also examined attitudes towards skin screening and the screening and referral patterns within this sample. For the purpose of this article the term ‘chiropractic student clinicians’ has been adopted to describe chiropractic students or interns in their final year of clinical study.