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Evidence-Based Dermatology: Review |

Critical Appraisal of Clinical Practice Guidelines for Adaptation in the Evidence-Based Guideline “Prevention of Skin Cancer”

Sonia Petrarca, MPH; Markus Follmann, MD, MPH, MSc; Eckhard W. Breitbart, MD; Sandra Nolte, PhD
JAMA Dermatol. 2013;149(4):466-471. doi:10.1001/jamadermatol.2013.3306.
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Importance During guideline development, it is essential to systematically review existing guidelines that may be suitable for adaptation; however, such review is laborious and may not always uncover useful guidelines.

Objective To identify existing clinical practice guidelines and assess their methodologic quality and suitability for adaptation in the German evidence-based guideline “Prevention of Skin Cancer.”

Evidence Acquisition A systematic literature search was performed across a range of databases and homepages of guideline development institutions. The AGREE Instrument (Appraisal of Guidelines Research and Evaluation) was used to assess the methodologic quality of selected guidelines.

Results A total of 480 citations were identified and screened. Of these, 12 guidelines were deemed suitable for potential adaptation. After comprehensive quality assessment, only 2 melanoma guidelines, one from Australia/New Zealand and the other from Scotland, were identified as being of high methodologic quality according to predefined selection criteria. Subsequent synopsis, however, revealed that neither of these guidelines was sufficiently comprehensive for full adaptation.

Conclusions and Relevance It is surprising that most existing skin cancer guidelines that contain aspects on prevention are not appropriate for adaptation, with most lacking methodologic quality, particularly rigor applied during the development process. Of the 2 guidelines that met the predefined quality criteria, only a few aspects—limited to malignant melanoma—were adaptable. We conclude that, despite the labor-intensive search for existing guidelines, a de novo development, including systematic literature review, is indispensible for the development of the German evidence-based guideline Prevention of Skin Cancer.

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Figure 1. Search terms used for systematic review of existing clinical practice guidelines on skin cancer prevention across a range of databases. G-I-N indicates Guidelines International Network; NICE, National Institute for Health and Clinical Excellence; SIGN, Scottish Intercollegiate Guidelines Network

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Figure 2. Results of the guideline quality appraisal focusing on the third domain (Rigor of Development) of AGREE (Appraisal of Guidelines Research and Evaluation).18 See cited references for all other abbreviation expansions.

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Figure 3. Results of the systematic review of existing clinical practice guidelines on skin cancer prevention. AGREE indicates Appraisal of Guidelines Research and Evaluation.18

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