As Skin Cancer Screening Increases, Clinicians Find More Thin Melanomas
Although regular population-based skin cancer screening isn’t recommended by the U.S. Preventive Services Task Force, more Americans are getting full-body skin exams at dermatology visits or other provider services. Data from a new study published in JAMA Dermatology (https://doi.org/10.1001/jamadermatol.2022.0253) suggest that the screening uptick is associated with increased diagnoses of early-stage, in situ melanoma, leading the researchers to raise concerns about overdiagnosis.
Of the 595,799 screening-eligible patients the researchers included in their quality improvement study, 144,851 (24.3%) were screened at least once. After five years of follow-up, they found (https://doi.org/10.1001/jamadermatol.2022.0253) that screened patients were more likely than unscreened patients to be diagnosed with in situ (30.4% versus 14.4%) or thin invasive (≤ 1 mm) melanoma (24.5% versus 16.1%). Screened patients were also more likely to have in situ (26.7% vs 12.9%) or thin invasive interval melanomas (melanoma diagnosed at least 60 days after initial screening examination) (18.5% versus 14.4%). Incidence of melanoma thicker than 4 mm in unscreened and screened patients, respectively, was 3.3% and 2.7% for all melanomas and 2.7% and 1.5% for interval melanomas.
“Primary care-based melanoma screening was associated with increased detection of thin melanoma, raising concern about overdiagnosis,” the researchers concluded (https://doi.org/10.1001/jamadermatol.2022.0253). “Further studies with longer follow-up are needed to determine the influence of screening on the incidence of thick melanoma and outcomes associated with high costs and poor outcomes, such as metastasis.”