Systematic review of advanced practice nurses' skin cancer detection knowledge and attitudes, clinical skin examination, lesion detection, and training

Background and purpose: Skin cancer is the most common malignancy in the United States; early detection reduces the public health burden. This systematic review updates the state of advanced practice nurses' skin cancer knowledge and attitudes, performance of and barriers to clinical skin examination (CSE), recognition of skin lesions, and related training activities. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided a search of eight literature databases that yielded 12 studies from 2010 to 2016. The United States Preventive Services Task Force's Levels of Certainty guided evidence assessment. Conclusions: The studies mainly targeted or included nurse practitioners. Collectively, participants had variable, suboptimal skin cancer knowledge, even after an intervention. A slight majority performed CSE during annual visits but agreed that CSE was important and within their scope of practice. Major CSE barriers were lack of time, training, and confidence. Participants who received training were more proficient in identifying suspicious versus benign lesions. Few skin cancer detection training opportunities for nurses exist. Implications: The level of certainty of the evidence for skin cancer detection by advanced practice nurses and their impact on the skin cancer problem remain low. These nurses would benefit from accessible and efficacious CSE and lesion training.