April 22, 2022
2 minute read
Disclosures: Matsumoto does not report any relevant financial information. Please see the study for relevant financial information from all other authors.
According to data published in JAMA Dermatology.
“Melanoma can be detected by a simple naked eye examination, and stage at diagnosis is the best predictor of prognosis, so routine skin cancer screening can reduce melanoma mortality,” Martha Matsumoto, MD, a dermatologist in Pittsburgh who is affiliated with United Hospital, and his colleagues wrote. “However, to our knowledge, no randomized clinical trials of screening for melanoma have been performed.”
To compare the thickness-specific incidence of melanoma in screened and unscreened patients, Matsumoto and colleagues conducted an observational study that included 595,799 people. Of these, 144,851 received at least one screening.
Patients screened were slightly older (median age, 59 vs 55), more likely to be female (56.8% vs 55.6%; P P
A total of 994 patients, including 356 screened patients, were diagnosed with melanoma of determined thickness. After 60 days from the first screening date, 110 patients in the screened group and 73 patients in the unscreened group were diagnosed with melanoma. The remaining melanoma diagnoses occurred during the observation period of the study and were considered interval melanomas.
After adjusting for age, gender, and Caucasian race, researchers found that melanomas among screened patients were more likely than those in unscreened patients to be in situ (HR=2.6; CI 95%, 2.1-3.1) or a thin invasive melanoma of 1 mm or less (HR=1.8; 95% CI, 1.5-2.2).
Matsumoto and colleagues also found that screened patients were more likely than unscreened patients to be diagnosed with interval melanomas in situ (HR=2.1; 95% CI, 1.7-2.6 ) or thin invasive lesions of 1 mm or less (HR = 1.3; 95% CI, 1-1.7).
“Our results and study design are important because we will be able to quantify the association of screening with overdiagnosis of melanoma (a potential harm from screening), and with longer follow-up time, with the incidence of thick melanomas (a benefit of screening that should influence survival, morbidity, and treatment costs),” Matsumoto and colleagues wrote.
The researchers concluded that screening for melanoma in older patients, especially men, can be cost-effective.
“Real-world data can add to this to help determine which patients, if any, can benefit from screening and optimal screening strategies that maximize benefits and minimize costs and harms,” Matsumoto and these partner’work. “Longer follow-up is needed to fully determine the association of screening with outcomes such as incidence of thick melanoma, treatment cost and morbidity, distant metastasis, and death.”