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Impact of Community-Based Skin Cancer Screening on Suspicious Skin Lesion Detection among Adults in Nigeria

Abstract

Skin cancer remains an important public health concern among adults in Nigeria, particularly because delayed recognition of suspicious skin lesions may result in late diagnosis, more advanced disease, increased treatment complexity, and poorer health outcomes. Adults may develop suspicious skin lesions due to prolonged ultraviolet radiation exposure, occupational exposure to sunlight, previous skin conditions, certain genetic factors, chronic wounds or scars, and other environmental and biological factors. Some potentially concerning lesions may initially appear harmless or produce little discomfort, causing individuals to delay seeking medical attention. Limited awareness of skin cancer warning signs, financial constraints, geographical barriers, shortage of specialist dermatological services, and misconceptions about skin lesions may further contribute to delayed assessment. Community-based skin cancer screening provides an opportunity to identify suspicious skin lesions through accessible visual skin examinations, health education, community outreach programmes, primary healthcare centres, mobile screening services, and referral pathways. Early identification of suspicious lesions may facilitate timely dermatological assessment, dermoscopic evaluation where available, biopsy when clinically indicated, and appropriate management. However, inadequate screening coverage, limited availability of trained healthcare personnel, insufficient diagnostic equipment, low public awareness, fear of cancer diagnosis, and weak referral and follow-up systems may limit the effectiveness of community-based skin cancer screening programmes in Nigeria. Against this background, this study investigates the impact of community-based skin cancer screening on suspicious skin lesion detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Community Health Theory, and the Health Systems Framework. The Health Belief Model explains how adults' perceptions of susceptibility to skin cancer, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based skin cancer screening. Community Health Theory emphasizes the delivery of accessible preventive health services through community structures and active community participation in health promotion, disease prevention, and early detection. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective skin cancer screening and referral programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based skin cancer screening may influence suspicious skin lesion detection among adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible adults. Community-based skin cancer screening will be measured using indicators such as availability of screening services, screening coverage, frequency of community screening activities, accessibility of screening locations, visual skin examination, assessment of skin cancer risk factors, availability of trained healthcare personnel, screening equipment, skin cancer awareness education, and referral arrangements. Suspicious skin lesion detection will be assessed using indicators such as newly identified suspicious lesions, abnormal lesion characteristics, lesion location and distribution, changes in lesion size, shape or colour, non-healing lesions, bleeding or ulcerated lesions, clinician-recommended referrals, dermatological assessment, dermoscopic evaluation where available, biopsy referrals where clinically indicated, and confirmed diagnosis following appropriate specialist assessment. Data will be collected using structured questionnaires, community screening registers, skin examination forms, healthcare facility records, dermatology referral records, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, skin examination findings, and patterns of suspicious skin lesion detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of community-based skin cancer screening on suspicious skin lesion detection. Where appropriate, detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based skin cancer screening has a significant positive impact on suspicious skin lesion detection among adults in Nigeria. Adults who participate in community-based skin cancer screening are expected to have a higher likelihood of having previously unrecognized suspicious skin lesions identified than adults without access to such services. Community-based screening may facilitate early recognition of lesions requiring further clinical assessment and provide opportunities for timely referral to dermatologists or other qualified healthcare professionals. Early identification may increase the likelihood of appropriate diagnostic evaluation, including dermoscopy or biopsy where clinically indicated, and timely management of confirmed skin conditions. Community-based skin cancer education may also improve awareness of warning signs and encourage adults to seek professional assessment of new or changing lesions. Conversely, inadequate screening coverage, limited diagnostic facilities, shortage of trained healthcare personnel, low awareness, financial constraints, fear of cancer diagnosis, and weak referral and follow-up systems may reduce the effectiveness of community-based skin cancer screening. The study therefore expects accessible and well-organized community-based skin cancer screening to contribute significantly to improved detection and early evaluation of suspicious skin lesions among adults in Nigeria. The study is expected to contribute to the literature on community-based skin cancer screening, suspicious skin lesion detection, adult health, dermatological health, cancer prevention, early cancer detection, community health services, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, dermatologists, community health workers, cancer control programmes, development partners, and policymakers regarding strategies for improving early recognition of suspicious skin lesions. The study will also provide evidence-based recommendations for expanding community-based skin cancer screening programmes, improving public awareness of skin cancer warning signs, strengthening training of healthcare workers in skin lesion recognition, increasing access to dermatological assessment and appropriate diagnostic services, improving referral and follow-up systems, reducing financial and geographical barriers to screening, and promoting early professional evaluation of suspicious skin lesions among adults across Nigeria.

Keywords: Community-based skin cancer screening, suspicious skin lesion detection, adults, skin cancer, dermatological screening, early cancer detection, skin health, cancer prevention, community health services, preventive healthcare, Nigeria, public health.