Clinical whole‐body skin examination reduces the incidence of thick melanomas

Abstract

Survival from melanoma is strongly related to tumour thickness, thus earlier diagnosis has the potential to reduce mortality from this disease. However, in the absence of conclusive evidence that clinical skin examination reduces mortality, evidencebased assessments do not recommend population screening. We aimed to assess whether clinical whole-body skin examination is associated with a reduced incidence of thick melanoma and also whether screening is associated with an increased incidence of thin lesions (possible overdiagnosis). We conducted a population-based case-control study of all Queensland residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 eligible cases (78.0%) and 3,824 eligible controls (50.4%). Whole-body clinical skin examination in the three years before diagnosis was associated with a 14% lower risk of being diagnosed with a thick melanoma (>0.75 mm) (OR 5 0.86, 95% CI 5 0.75, 0.98). Risk decreased for melanomas of increasing thickness: the risk of being diagnosed with a melanoma 0.76-1.49 mm was reduced by 7% (OR 5 0.93, 95% CI 0.79, 1.10), by 17% for melanomas 1.50-2.99 mm (OR 5 0.83, 95% CI 5 0.65, 1.05) and by 40% for melanomas !3 mm (OR 5 0.60, 95% CI 5 0.43, 0.83). Screening was associated with a 38% higher risk of being diagnosed with a thin invasive melanoma ( 0.75 mm) (OR 5 1.38, 95% CI 5 1.22, 1.56). This is the strongest evidence to date that whole-body clinical skin examination reduces the incidence of thick melanoma. Because survival from melanoma is strongly related to tumour thickness, these results suggest that screening would reduce melanoma mortality.

Association between melanoma thickness, clinical skin examination and socioeconomic status: Results of a large population‐based study

“…In addition, we found a higher risk of thick melanoma among those who were retired and among those who were not currently married or living as married. We have previously reported 6 that CSE in the past 3 years significantly reduces the risk of thick melanoma, and the results here suggest that it may be a mediator between education and melanoma thickness.…”

“…Because CSE is independently related to lower risk of thick melanoma, 6 this association is enhanced further, as those with higher education are also more likely to participate in CSE. As survival from melanoma is strongly related to melanoma thickness, these results suggest that a thorough understanding of how education and other measures of SES impact on melanoma thickness and CSEs should be a research priority.…”

“…5 Having had a whole-body clinical skin examination (CSE) in the past 3 years has been shown to significantly reduce the risk of thick melanoma. 6 Factors related to increased risk of thick melanoma include low socioeconomic status (SES) 7 and lower educational attainment. [8][9][10][11] In line with this, melanoma survival rates are generally poorer among people with lower SES.…”

Clinical Presentation and Staging of Melanoma

“…Another study with similar findings was performed in Australia in 2008. This case-control study demonstrated a 38% increase in the probability of a thin melanoma (<0.75 mm) being identified and that pre-diagnosis WBE screening leads to a 14% risk reduction of thick melanoma (>0.75 mm) diagnosis (5).…”

“…Like most other neoplastic conditions, known risk factors of melanoma include genetic defects, environmental exposure, and a combination of both (5). Although multiple genetic syndromes incur a significantly increased risk for the development of cutaneous malignancy (discussed later), inherited phenotypic traits associated with melanoma include fair skin, light hair, red hair, freckles, and light eye color.…”