Melanoma Screening May Be Most Effective In Older Patients With Risk Factors

Academic Journal
Main Category: Melanoma / Skin Cancer
Also Included In: Dermatology;  Cancer / Oncology;  Seniors / Aging
Article Date: 17 Jun 2011 - 3:00 PDT


Dermatologists are most likely to discover melanomas in patients ages 50 years or older with a personal history of skin cancer or a family history of melanoma, according to a report in the June issue of Archives of Dermatology, one of the JAMA/Archives journals.

As background, the article notes that melanoma is a fairly common and serious cancer, with death rates correlating to advancing age. "Melanoma outcome is strongly determined by tumor thickness at the time of diagnosis," the authors write, by way of explaining the rationale for melanoma screenings. The hope is that screening will find cancers in the early stage and therefore reduce the chances that patients will become ill or die. "However," the researchers add, "determining which group of patients is least likely to self-detect melanoma, or to detect melanoma only at a later stage, would be useful in making more pragmatic decisions regarding the benefits of skin cancer screening and surveillance recommendations."

Sean T. McGuire, B.S., and colleagues from the University of Pittsburgh conducted a retrospective study of 167 patients. The participants' melanomas were diagnosed through the university's medical center and confirmed by biopsy between January 2003 and December 2008. Researchers sought to learn how many lesions were detected by a dermatologist versus by a patient, as well as the characteristics of patients who self-detected their lesions.

Most melanomas (101, or 60.5 percent) were discovered by patients. Dermatologists were most likely to detect melanoma in patients who were at least 50 years of age and who had a personal history of melanoma or other skin cancer; half the melanomas in the study in patients in this age group were found by clinicians. Patients who were younger and had fewer risk factors were more likely to detect lesions themselves. Of all the melanomas detected in the study, just 3 percent (5 lesions) were found by dermatologists in low-risk patients.

The researchers mention that melanoma screening can have drawbacks, especially in low-risk patients, including aggressive and expensive treatment for lesions that may be indolent (slow to progress to a harmful stage). They hope this study will "aid in understanding which patients will benefit most from screening for melanoma by a dermatologist." Lastly, the authors urge more research, and also "public health efforts to educate" lower-risk patients about melanoma, as opposed to large-scale screenings.

Arch Dermatol. 2011;147[6]:673-678

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