Large-scale melanoma screening ‘feasible’ in large healthcare systems
medwireNews: The rate of melanoma diagnoses can be doubled with routine screening by full-body skin examination (FBSE) and is feasible within a large healthcare system, US study data show.
Furthermore, the intervention, which offered melanoma screening to patients aged 35 years or older during a routine primary care visit, resulted in increased detection of thin, earlier-stage melanoma, among screened versus unscreened patients.
“[W]e show in the current intervention that screening with FBSE can be performed on a large scale without additional physician compensation and may increase detection of melanoma at its most curable stages,” write Laura Ferris (University of Pittsburgh, Pennsylvania) and colleagues in JAMA Oncology.
Of 333,735 screen-eligible adult patients seen by primary care physicians at the University of Pittsburgh Medical Center in 2014, 53,196 (15.9%) received an FBSE.
The screened patients were slightly older than the 280,539 eligible patients who did not receive screening (median age, 60 vs 57 years) but they did not differ by gender (43.2% vs 43.1% men).
The researchers note that their approach “resulted in a higher rate of screening than previous screening interventions among men and older patients, the groups at highest risk of melanoma.”
During the study period, 50 melanomas were diagnosed in the screened patients compared with 104 in the unscreened patients, giving respective incidence rates of 94.0 and 37.1 cases per 100,000 individuals and an adjusted relative risk (aRR) of 2.4.
Of the 154 melanomas detected overall, 95 were invasive. The median Breslow thickness of the invasive melanomas in screened patients (n=26) was significantly lower than that in unscreened patients (n=45), at 0.37 versus 0.65 mm, and screened patients were more than twice as likely as unscreened patients to have melanomas with a Breslow thickness below 1.00 mm (aRR=2.6).
Ferris and team describe this finding as “clinically significant” because “Breslow depth is the strongest indicator of melanoma mortality.”
They add: “While it is true that predominantly thin melanomas were detected in the present program, more people actually die from melanomas thinner than 1 mm than from those thicker than 4 mm.
“The thinner lesions have a lower case-based mortality rate, but their incidence is much greater in the population, hence the potential importance of their diagnosis.”
The authors conclude: “Future studies will be needed to definitively quantify the impact of this approach on melanoma thickness, mortality, and health care costs and to determine which patients benefit most from screening.”
By Laura Cowen
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