- Email: [email protected]
1999 Special Olympics World Summer Games: Dermatologic health screening results
700 Brief reports
J AM ACAD DERMATOL APRIL 2001
1999 Special Olympics World Summer Games: Dermatologic health screening results Alan B. Fleischer, Jr, MD,a Steven R. Feldman, MD, PhD,a Frederick A. Lupton, MD,b and Harry R. Holden, ADc Winston-Salem and Greensboro, North Carolina, and Atlanta, Georgia
A
lthough pilot studies on visual health1 and dental health2 screening are available, no comprehensive international study has ever been completed on the dermatologic health status of people with disabilities. Special Olympics is an international program of year-round sports training and athletic competition for children and adults with mental retardation. Special Olympics began in 1968 when Eunice Kennedy Shriver organized the First International Special Olympics Games at Soldier Field, Chicago, Illinois. The concept was born in the early 1960s when Mrs Shriver started a day camp for people with mental retardation. She saw that people with mental retardation were far more capable in sports and physical activities than many experts thought. Since 1968, millions of children and adults with mental retardation have participated in Special Olympics.* To be eligible to participate in Special Olympics, athletes must be at least 8 years old and identified by an agency or professional as having one of the following conditions: mental retardation, cognitive delays as measured by formal assessment, or significant learning or vocational problems due to cognitive delay that require or have required specially designed instruction.* The 1999 Special Olympics World Summer Games provided a unique opportunity to furnish a comprehensive skin examination program to an international cross-section of persons with special needs. This program was part of a larger health screening effort, which included musculoskeletal, dental, optometric, *Web
site: http://www.specialolympics.org/about_special_olympics/ index.html
From the Bristol-Myers Squibb Center for Dermatology Research and the Department of Dermatology,Wake Forest University School of Medicine, Winston-Salema; private practice, Greensborob; and the Centers for Disease Control and Prevention, Atlanta.c Supported by Bristol-Myers Squibb Center for Dermatology Research. Reprints not available from authors. J Am Acad Dermatol 2001;44:700-3. 16/54/112459 doi:10.1067/mjd.2001.112459
and other screening examinations. The dermatologic health status screening program was initiated as a cooperative effort between the Special Olympics, the American Academy of Dermatology (AAD), the North Carolina Dermatology Association, individual volunteer dermatologists, the Westwood-Squibb (currently Bristol-Myers Squibb) Center for Dermatology Research, local university dermatology training programs (Duke University, University of North Carolina at Chapel Hill, and Wake Forest University), and the Centers for Disease Control and Prevention (CDC) (H. R. H.). Another co-author (F. A. L.) coordinated the program’s physician activities. This screening effort was offered to improve the dermatologic health status of individual athletes by diagnosing and providing information to the athletes and/or their caregivers. In addition, a secondary goal was to obtain epidemiologic information regarding skin diseases identified in this population.
METHODS A comprehensive MEDLINE literature review from 1966 to 1999 was performed to determine the types of skin disorders that may be seen in special populations. To gain additional data regarding the types of disorders expected, a focus group of dermatologists was conducted at the Wake Forest University School of Medicine. Because there was no previously published information about the types of diseases, frequency of diseases, and disease severity in this population, a data collection form was designed to obtain demographic information and to allow any and all observed diagnoses to be captured. A data entry program was created with the use of EpiInfo (CDC, Atlanta, Ga), and this program was loaded onto laptop computers (provided by Glaxo Dermatology). Each data entry form on each computer was individually tested for ease of data entry and data integrity. Subjective severity ratings were asked of examiners for 4 diagnoses: acne vulgaris, atopic dermatitis, seborrheic dermatitis, and rosacea. The skin examinations were conducted on site at the 1999 Special Olympics World Summer Games in
Brief reports 701
J AM ACAD DERMATOL VOLUME 44, NUMBER 4
Chapel Hill, NC. Before the screening event, dermatologists could participate in a 4-hour training session designed to instruct physicians in ways to interact with this population as well as ways to help organize future screenings of special athletes competing in local Special Olympics Games. All athletes were examined by dermatologists or supervised residents from the participating residency programs. A total of 54 dermatologists participated, including 40 attending physicians and 14 dermatology residents. Assistance was also provided by 10 AAD staff members and numerous local volunteers. Athletes chose whether to have problem-focused examinations or more general examinations. Interpretive services were often needed and were usually provided by the teams’ coaches. All athletes received counseling and education from dermatologists and after the screening were provided with dermatology-specific patient education materials tailored for persons with lower reading levels. Data gleaned from these examinations were entered into individual computers at the bedside. Data were entered with either ICD-9-CM codes or condition name.3 All physicians had cards available including multiple dermatologic ICD-9 codes to aid in the process. Diagnoses entered by disease name were later recoded by one of the investigators (A. B. F.) using the appropriate ICD-9 code for further analysis. After completion of the Special Olympics, individual computer files were merged into one dataset. Data analysis was performed using SAS (SAS Institute, Cary, NC) at the Westwood-Squibb Center for Dermatology Research.
RESULTS
Table I. Age distribution of special athletes
Age group (range [y])
Minors (0-12) Adolescents (13-19) Young adults (20-29) Adults (30-50) Seniors (51-99) Total
No. of total athletes participating in Special Olympics
216 (3.3%) 2608 (39.7%) 2326 (35.4%) 1353 (20.6%) 69 (1.0%) 6572
No. of total screened athletes
22 (1.8%) 489 (40.2%) 446 (36.7%) 256 (21.0%) 4 (0.3%) 1217
expected in this generally young population. Other common diagnoses (Table II) included benign neoplasms, superficial fungal infections (including onychomycosis), dermatitis, warts, and hair disorders. Twenty athletes (1.6%) were diagnosed as having a precancerous skin lesion (atypical nevus or actinic keratosis) or skin cancer. The bulk of these were atypical nevi, but one actinic keratosis was identified. In addition, one 38-year-old athlete was clinically diagnosed as having a basal cell carcinoma and another 25-year-old athlete was diagnosed with a melanoma. Subjective disease severity Of the 430 athletes diagnosed with acne, disease severity information is available on 359 (83%). Of these, 277 (77%) were rated as having mild disease, 73 (20%) moderate disease, and 9 (3%) severe disease. Of the 23 athletes diagnosed with atopic dermatitis, we have data on 14 (61%). Of these, 11 (79%) had mild atopic dermatitis and 4 (29%) had moderate. Of the 7 patients with rosacea, 6 (86%) had mild disease, whereas 1 (14%) had moderately severe disease. Of 27 patients with seborrheic dermatitis, 26 (96%) had mild disease, whereas 1 (4%) had severe disease.
Demographics of athletes Data are available from a total of 1217 Special Olympics athletes screened in North Carolina. A total of 6572 athletes participated; thus 18.5% of those eligible participated in the screening. The male/female ratio of screened athletes was 1.2:1, whereas the male/female ratio of all athletes was 1.8:1. The age distribution of the screened athletes was comparable to the age distribution of all special athletes (Table I). The screened athletes had a mean age of 23.4 ± 8.9 years and represented teams from Argentina to Zimbabwe.
DISCUSSION
Dermatologic conditions Dermatologic diagnoses were made in 901 (74%) of this special population. There was no difference in age (P = .4) or sex (P = .14) between those diagnosed and those not diagnosed with skin conditions. The most common diagnosis was acne, as would be
The Special Olympics Dermatology Health Screening program was important in several ways. There was active participation by a large number of volunteer dermatologists. The program offered comprehensive skin examinations to an international cross-section of persons with special needs. The program represented an opportunity to make the gen-
Difficulties encountered Data entry was noted by some dermatologists to be difficult because ICD-9 codes lack required specificity for the diagnosis of certain entities, such as differentiation of benign tumors.
702 Brief reports
J AM ACAD DERMATOL APRIL 2001
Table II. List of diagnoses ICD-9 code
706.10 110.40 216.90 078.10 704.80 757.39 110.90 690.10 692.90 110.10 691.80 709.09 700.00 709.20 686.90 704.80 111.00 704.10 238.20 701.40 228.01 701.10 684.00 703.80 695.30 698.30 696.10 701.20 702.19 706.80 707.00 706.20 919.20 110.50 454.90 214.90 698.90 701.30 704.01
Description
Acne vulgaris Dermatophytosis of foot Benign neoplasm skin NOS Viral warts NOS Hair diseases NEC Skin anomaly NEC Dermatophytosis site NOS Seborrheic dermatitis NOS Dermatitis NOS Dermatophytosis of nail Atopic dermatitis Dyschromia Corns and callosities Scar and fibrosis of skin Local skin infection NOS Bullous dermatoses NEC Pityriasis versicolor Hirsutism Uncertain behavior neoplasm of skin Keloid scar Hemangioma skin Keratoderma, acquired Impetigo Diseases of nail NEC Rosacea Lichenification Psoriasis Acquired acanthosis nigricans Other seborrheic keratosis Sebaceous gland disease NEC Decubitus ulcer Sebaceous cyst Blister NEC Dermatophytosis of body Varicose vein of leg NOS Lipoma NOS Pruritic disorder NOS Striae atrophicae Alopecia areata
Observed
430 221 153 45 42 35 28 27 27 26 23 19 18 18 13 13 12 12 11 10 9 9 9 9 7 7 6 6 6 6 6 5 4 3 3 3 3 3 3
ICD-9 code
709.00 709.90 757.10 919.40 078.00 110.30 528.50 681.00 695.89 698.40 705.10 705.81 709.01 757.32 757.50 759.50 782.70 911.40 917.20 054.90 110.60 112.80 172.90 173.90 448.90 523.10 695.40 696.40 702.00 706.80 709.80 780.80 782.00 782.10 782.61 919.00 924.10 924.90
Description
Dyschromia, unspecified Skin disorder NOS Ichthyosis congenita Insect bite NEC Molluscum contagiosum Dermatophytosis of groin Diseases of lips Cellulitis, finger NOS Erythematous condition NEC Dermatitis factitia Prickly heat Dyshidrosis Vitiligo Vascular hamartomas Nail anomalies NEC Tuberous sclerosis Spontaneous ecchymoses Insect bite trunk Blister foot and toe Herpes simplex NOS Deep dermatophytosis Candidiasis other sites Malignant melanoma of skin NOS Malignant neoplasm of skin NOS basal cell) Capillary disease NEC/NOS Chronic gingivitis Lupus erythematosus Pityriasis rubra pilaris Actinic keratosis Sebaceous gland disease NEC Skin disorders NEC Hyperhidrosis Skin/other integument symptom Nonspecific skin eruption NEC Pallor Abrasion NEC Contusion of lower leg Contusion NOS
Observed
3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
NEC, Not elsewhere; NOS, not otherwise specified.
eral public more aware of the need for skin examinations. In addition, dermatologists present uniformly enjoyed the screening experience, and we perceived that there was some surprise on the part of dermatologists as to how functional and competent this special population was. This Dermatologic Health Screening program also is the first of its type to provide preliminary assessment of cutaneous disorders in this special needs population. Dermatologic disorders are common in this population. The majority of athletes did have one or more skin conditions identified during the event. The distribution of diagnoses appears
generally similar to the distribution in the general population.4 Dermatologists detected two probable skin cancers including one melanoma and one basal cell carcinoma. Athletes and others with special needs should be considered a population at risk for skin cancer, no different from those in the general population. Because of the relatively small number of subjects screened and the lack of follow-up information, it is difficult to compare the skin cancer detection rate of this study with other mass screening results such as the National Skin Cancer Early Detection and Screening Program of the AAD.5
J AM ACAD DERMATOL VOLUME 44, NUMBER 4
Limitations of this study must be addressed. This study was conducted of individual athletes capable of participation in the Special Olympics programs. This population may not be representative of other special populations. Nevertheless, the Special Olympics opportunity offers the ability to bring together people who would not ordinarily be together from multiple countries and with multiple disabilities. Next, participation in the screening program was not mandatory, and accordingly athletes with other dermatologic disorders may have been missed. The gender distribution shows that we screened proportionately more women than men, but women generally have higher medical utilization rates than men. Because the age distribution of athletes corresponds with the age distribution of all participating athletes, we believe it is likely that we obtained a reasonably representative cross-section of the total group. Because disease severity ratings were not standardized, they represent the subjective perceptions of the individual dermatologists performing these examinations. The 1999 Special Olympics World Summer Games provided the first opportunity to provide and examine dermatologic health screening. The success of this program proves that such screening can be accomplished and should pave the way for similar programs in future years. With the data generated from this study, hypothesis testing could be incorpo-
Brief reports 703
rated into future mass screening programs of special populations. We thank the staff of the AAD and Dr Roger I. Ceilley for their intense effort in organizing this effort. Glaxo Dermatology generously provided the laptop computers used by all dermatologists for the on-site data entry. We thank Dr Joseph L. Jorizzo for his excellent guidance and ongoing support of advanced research computing. Most importantly, we thank the true heroes that made this project possible: the participating dermatologists and the staff of Special Olympics. REFERENCES 1. Block SS, Beckerman SA, Berman PE. Vision profile of the athletes of the 1995 Special Olympics World Summer Games. J Am Optom Assoc 1997;68:699-708. 2. Feldman CA, Giniger M, Sanders M, Saporito R, Zohn HK, Perlman SP. Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection. J Am Dent Assoc 1997;128:1687-96. 3. Physicians ICD-9-CM; vol 1. Salt Lake City: Medicode Publications; 1997. 4. Thompson TT, Feldman SR, Fleischer AB Jr. Only 33% of visits for skin disease in the US in 1995 were to dermatologists: is decreasing the number of dermatologists the appropriate response? Dermatol Online J 1998;4:3. 5. Koh HK, Norton LA, Geller AC, Sun T, Rigel DS, Miller DR, et al. Evaluation of the American Academy of Dermatology’s National Skin Cancer Early Detection and Screening Program. J Am Acad Dermatol 1996;34:971-8.
J AM ACAD DERMATOL APRIL 2001
1999 Special Olympics World Summer Games: Dermatologic health screening results Alan B. Fleischer, Jr, MD,a Steven R. Feldman, MD, PhD,a Frederick A. Lupton, MD,b and Harry R. Holden, ADc Winston-Salem and Greensboro, North Carolina, and Atlanta, Georgia
A
lthough pilot studies on visual health1 and dental health2 screening are available, no comprehensive international study has ever been completed on the dermatologic health status of people with disabilities. Special Olympics is an international program of year-round sports training and athletic competition for children and adults with mental retardation. Special Olympics began in 1968 when Eunice Kennedy Shriver organized the First International Special Olympics Games at Soldier Field, Chicago, Illinois. The concept was born in the early 1960s when Mrs Shriver started a day camp for people with mental retardation. She saw that people with mental retardation were far more capable in sports and physical activities than many experts thought. Since 1968, millions of children and adults with mental retardation have participated in Special Olympics.* To be eligible to participate in Special Olympics, athletes must be at least 8 years old and identified by an agency or professional as having one of the following conditions: mental retardation, cognitive delays as measured by formal assessment, or significant learning or vocational problems due to cognitive delay that require or have required specially designed instruction.* The 1999 Special Olympics World Summer Games provided a unique opportunity to furnish a comprehensive skin examination program to an international cross-section of persons with special needs. This program was part of a larger health screening effort, which included musculoskeletal, dental, optometric, *Web
site: http://www.specialolympics.org/about_special_olympics/ index.html
From the Bristol-Myers Squibb Center for Dermatology Research and the Department of Dermatology,Wake Forest University School of Medicine, Winston-Salema; private practice, Greensborob; and the Centers for Disease Control and Prevention, Atlanta.c Supported by Bristol-Myers Squibb Center for Dermatology Research. Reprints not available from authors. J Am Acad Dermatol 2001;44:700-3. 16/54/112459 doi:10.1067/mjd.2001.112459
and other screening examinations. The dermatologic health status screening program was initiated as a cooperative effort between the Special Olympics, the American Academy of Dermatology (AAD), the North Carolina Dermatology Association, individual volunteer dermatologists, the Westwood-Squibb (currently Bristol-Myers Squibb) Center for Dermatology Research, local university dermatology training programs (Duke University, University of North Carolina at Chapel Hill, and Wake Forest University), and the Centers for Disease Control and Prevention (CDC) (H. R. H.). Another co-author (F. A. L.) coordinated the program’s physician activities. This screening effort was offered to improve the dermatologic health status of individual athletes by diagnosing and providing information to the athletes and/or their caregivers. In addition, a secondary goal was to obtain epidemiologic information regarding skin diseases identified in this population.
METHODS A comprehensive MEDLINE literature review from 1966 to 1999 was performed to determine the types of skin disorders that may be seen in special populations. To gain additional data regarding the types of disorders expected, a focus group of dermatologists was conducted at the Wake Forest University School of Medicine. Because there was no previously published information about the types of diseases, frequency of diseases, and disease severity in this population, a data collection form was designed to obtain demographic information and to allow any and all observed diagnoses to be captured. A data entry program was created with the use of EpiInfo (CDC, Atlanta, Ga), and this program was loaded onto laptop computers (provided by Glaxo Dermatology). Each data entry form on each computer was individually tested for ease of data entry and data integrity. Subjective severity ratings were asked of examiners for 4 diagnoses: acne vulgaris, atopic dermatitis, seborrheic dermatitis, and rosacea. The skin examinations were conducted on site at the 1999 Special Olympics World Summer Games in
Brief reports 701
J AM ACAD DERMATOL VOLUME 44, NUMBER 4
Chapel Hill, NC. Before the screening event, dermatologists could participate in a 4-hour training session designed to instruct physicians in ways to interact with this population as well as ways to help organize future screenings of special athletes competing in local Special Olympics Games. All athletes were examined by dermatologists or supervised residents from the participating residency programs. A total of 54 dermatologists participated, including 40 attending physicians and 14 dermatology residents. Assistance was also provided by 10 AAD staff members and numerous local volunteers. Athletes chose whether to have problem-focused examinations or more general examinations. Interpretive services were often needed and were usually provided by the teams’ coaches. All athletes received counseling and education from dermatologists and after the screening were provided with dermatology-specific patient education materials tailored for persons with lower reading levels. Data gleaned from these examinations were entered into individual computers at the bedside. Data were entered with either ICD-9-CM codes or condition name.3 All physicians had cards available including multiple dermatologic ICD-9 codes to aid in the process. Diagnoses entered by disease name were later recoded by one of the investigators (A. B. F.) using the appropriate ICD-9 code for further analysis. After completion of the Special Olympics, individual computer files were merged into one dataset. Data analysis was performed using SAS (SAS Institute, Cary, NC) at the Westwood-Squibb Center for Dermatology Research.
RESULTS
Table I. Age distribution of special athletes
Age group (range [y])
Minors (0-12) Adolescents (13-19) Young adults (20-29) Adults (30-50) Seniors (51-99) Total
No. of total athletes participating in Special Olympics
216 (3.3%) 2608 (39.7%) 2326 (35.4%) 1353 (20.6%) 69 (1.0%) 6572
No. of total screened athletes
22 (1.8%) 489 (40.2%) 446 (36.7%) 256 (21.0%) 4 (0.3%) 1217
expected in this generally young population. Other common diagnoses (Table II) included benign neoplasms, superficial fungal infections (including onychomycosis), dermatitis, warts, and hair disorders. Twenty athletes (1.6%) were diagnosed as having a precancerous skin lesion (atypical nevus or actinic keratosis) or skin cancer. The bulk of these were atypical nevi, but one actinic keratosis was identified. In addition, one 38-year-old athlete was clinically diagnosed as having a basal cell carcinoma and another 25-year-old athlete was diagnosed with a melanoma. Subjective disease severity Of the 430 athletes diagnosed with acne, disease severity information is available on 359 (83%). Of these, 277 (77%) were rated as having mild disease, 73 (20%) moderate disease, and 9 (3%) severe disease. Of the 23 athletes diagnosed with atopic dermatitis, we have data on 14 (61%). Of these, 11 (79%) had mild atopic dermatitis and 4 (29%) had moderate. Of the 7 patients with rosacea, 6 (86%) had mild disease, whereas 1 (14%) had moderately severe disease. Of 27 patients with seborrheic dermatitis, 26 (96%) had mild disease, whereas 1 (4%) had severe disease.
Demographics of athletes Data are available from a total of 1217 Special Olympics athletes screened in North Carolina. A total of 6572 athletes participated; thus 18.5% of those eligible participated in the screening. The male/female ratio of screened athletes was 1.2:1, whereas the male/female ratio of all athletes was 1.8:1. The age distribution of the screened athletes was comparable to the age distribution of all special athletes (Table I). The screened athletes had a mean age of 23.4 ± 8.9 years and represented teams from Argentina to Zimbabwe.
DISCUSSION
Dermatologic conditions Dermatologic diagnoses were made in 901 (74%) of this special population. There was no difference in age (P = .4) or sex (P = .14) between those diagnosed and those not diagnosed with skin conditions. The most common diagnosis was acne, as would be
The Special Olympics Dermatology Health Screening program was important in several ways. There was active participation by a large number of volunteer dermatologists. The program offered comprehensive skin examinations to an international cross-section of persons with special needs. The program represented an opportunity to make the gen-
Difficulties encountered Data entry was noted by some dermatologists to be difficult because ICD-9 codes lack required specificity for the diagnosis of certain entities, such as differentiation of benign tumors.
702 Brief reports
J AM ACAD DERMATOL APRIL 2001
Table II. List of diagnoses ICD-9 code
706.10 110.40 216.90 078.10 704.80 757.39 110.90 690.10 692.90 110.10 691.80 709.09 700.00 709.20 686.90 704.80 111.00 704.10 238.20 701.40 228.01 701.10 684.00 703.80 695.30 698.30 696.10 701.20 702.19 706.80 707.00 706.20 919.20 110.50 454.90 214.90 698.90 701.30 704.01
Description
Acne vulgaris Dermatophytosis of foot Benign neoplasm skin NOS Viral warts NOS Hair diseases NEC Skin anomaly NEC Dermatophytosis site NOS Seborrheic dermatitis NOS Dermatitis NOS Dermatophytosis of nail Atopic dermatitis Dyschromia Corns and callosities Scar and fibrosis of skin Local skin infection NOS Bullous dermatoses NEC Pityriasis versicolor Hirsutism Uncertain behavior neoplasm of skin Keloid scar Hemangioma skin Keratoderma, acquired Impetigo Diseases of nail NEC Rosacea Lichenification Psoriasis Acquired acanthosis nigricans Other seborrheic keratosis Sebaceous gland disease NEC Decubitus ulcer Sebaceous cyst Blister NEC Dermatophytosis of body Varicose vein of leg NOS Lipoma NOS Pruritic disorder NOS Striae atrophicae Alopecia areata
Observed
430 221 153 45 42 35 28 27 27 26 23 19 18 18 13 13 12 12 11 10 9 9 9 9 7 7 6 6 6 6 6 5 4 3 3 3 3 3 3
ICD-9 code
709.00 709.90 757.10 919.40 078.00 110.30 528.50 681.00 695.89 698.40 705.10 705.81 709.01 757.32 757.50 759.50 782.70 911.40 917.20 054.90 110.60 112.80 172.90 173.90 448.90 523.10 695.40 696.40 702.00 706.80 709.80 780.80 782.00 782.10 782.61 919.00 924.10 924.90
Description
Dyschromia, unspecified Skin disorder NOS Ichthyosis congenita Insect bite NEC Molluscum contagiosum Dermatophytosis of groin Diseases of lips Cellulitis, finger NOS Erythematous condition NEC Dermatitis factitia Prickly heat Dyshidrosis Vitiligo Vascular hamartomas Nail anomalies NEC Tuberous sclerosis Spontaneous ecchymoses Insect bite trunk Blister foot and toe Herpes simplex NOS Deep dermatophytosis Candidiasis other sites Malignant melanoma of skin NOS Malignant neoplasm of skin NOS basal cell) Capillary disease NEC/NOS Chronic gingivitis Lupus erythematosus Pityriasis rubra pilaris Actinic keratosis Sebaceous gland disease NEC Skin disorders NEC Hyperhidrosis Skin/other integument symptom Nonspecific skin eruption NEC Pallor Abrasion NEC Contusion of lower leg Contusion NOS
Observed
3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
NEC, Not elsewhere; NOS, not otherwise specified.
eral public more aware of the need for skin examinations. In addition, dermatologists present uniformly enjoyed the screening experience, and we perceived that there was some surprise on the part of dermatologists as to how functional and competent this special population was. This Dermatologic Health Screening program also is the first of its type to provide preliminary assessment of cutaneous disorders in this special needs population. Dermatologic disorders are common in this population. The majority of athletes did have one or more skin conditions identified during the event. The distribution of diagnoses appears
generally similar to the distribution in the general population.4 Dermatologists detected two probable skin cancers including one melanoma and one basal cell carcinoma. Athletes and others with special needs should be considered a population at risk for skin cancer, no different from those in the general population. Because of the relatively small number of subjects screened and the lack of follow-up information, it is difficult to compare the skin cancer detection rate of this study with other mass screening results such as the National Skin Cancer Early Detection and Screening Program of the AAD.5
J AM ACAD DERMATOL VOLUME 44, NUMBER 4
Limitations of this study must be addressed. This study was conducted of individual athletes capable of participation in the Special Olympics programs. This population may not be representative of other special populations. Nevertheless, the Special Olympics opportunity offers the ability to bring together people who would not ordinarily be together from multiple countries and with multiple disabilities. Next, participation in the screening program was not mandatory, and accordingly athletes with other dermatologic disorders may have been missed. The gender distribution shows that we screened proportionately more women than men, but women generally have higher medical utilization rates than men. Because the age distribution of athletes corresponds with the age distribution of all participating athletes, we believe it is likely that we obtained a reasonably representative cross-section of the total group. Because disease severity ratings were not standardized, they represent the subjective perceptions of the individual dermatologists performing these examinations. The 1999 Special Olympics World Summer Games provided the first opportunity to provide and examine dermatologic health screening. The success of this program proves that such screening can be accomplished and should pave the way for similar programs in future years. With the data generated from this study, hypothesis testing could be incorpo-
Brief reports 703
rated into future mass screening programs of special populations. We thank the staff of the AAD and Dr Roger I. Ceilley for their intense effort in organizing this effort. Glaxo Dermatology generously provided the laptop computers used by all dermatologists for the on-site data entry. We thank Dr Joseph L. Jorizzo for his excellent guidance and ongoing support of advanced research computing. Most importantly, we thank the true heroes that made this project possible: the participating dermatologists and the staff of Special Olympics. REFERENCES 1. Block SS, Beckerman SA, Berman PE. Vision profile of the athletes of the 1995 Special Olympics World Summer Games. J Am Optom Assoc 1997;68:699-708. 2. Feldman CA, Giniger M, Sanders M, Saporito R, Zohn HK, Perlman SP. Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection. J Am Dent Assoc 1997;128:1687-96. 3. Physicians ICD-9-CM; vol 1. Salt Lake City: Medicode Publications; 1997. 4. Thompson TT, Feldman SR, Fleischer AB Jr. Only 33% of visits for skin disease in the US in 1995 were to dermatologists: is decreasing the number of dermatologists the appropriate response? Dermatol Online J 1998;4:3. 5. Koh HK, Norton LA, Geller AC, Sun T, Rigel DS, Miller DR, et al. Evaluation of the American Academy of Dermatology’s National Skin Cancer Early Detection and Screening Program. J Am Acad Dermatol 1996;34:971-8.