All-cause, but not melanoma-specific, mortality reduced by skin checks, finds study

By Rebecca Jenkins
Melanomas detected through routine skin checks are associated with lower all-cause mortality but not significantly lower melanoma-specific mortality, Australian research finds.

For the prospective population-based cohort study, researchers used linked mortality and cancer registry data from 2452 patients in New South Wales enrolled in the Melanoma Patterns of Care Study who were diagnosed with a melanoma between October 2006 and October 2007.

They found people whose melanoma was detected by a doctor during a routine skin check were 59% less likely to die from that melanoma over the next 12 years compared with patients who detected their own melanoma, whereas deaths from all causes were 36% lower among people whose melanoma was detected in a routine skin check.

However, when researchers adjusted for prognostic variables, including mitotic rate and ulceration, they found a 32% reduction in melanoma-specific mortality which did not reach statistical significance.

There remained a statistically significant 25% reduction in all-cause mortality associated with routine skin checks, but the authors urged caution in interpreting this finding.

‘The fact that routine skin-check melanoma detection was significantly associated with lower all-cause mortality but not melanoma-specific mortality in fully adjusted analyses may reflect residual or unmeasured confounding from socio-demographic characteristics (such as education level), medical access, and health-seeking behaviours (such as physical activity) that are independently associated with both routine skin checks and overall mortality,’ the researchers wrote in JAMA Dermatology.

A total of 858 patients (35%) had their melanoma detected during a routine skin check, 1148 (47%) detected the melanoma themselves, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion and 153 (6%) reported another presentation.

There were higher odds of melanoma being detected at a routine skin check among men, those with a previous melanoma, those with many moles, patients aged 50 years or older or those living in nonremote areas.

The authors concluded that a large, randomised trial was needed to provide definitive evidence that screening for skin cancer reduces melanoma-specific and all-cause mortality among people invited to screen, but there were feasibility issues.

Lead author Professor Anne Cust, Deputy Director of the Daffodil Centre at The University of Sydney and Cancer Council NSW and Faculty member of the Melanoma Institute Australia, told Medicine Today the study had aimed to better understand how melanoma was detected and to examine the question of whether routine skin checks saved lives, as previous evidence had not been able to provide an answer.

She remained hopeful that it would be possible to conduct a large randomised controlled trial on melanoma screening in the future.

‘My team is currently modelling the potential benefits, harms, cost-effectiveness and resource implications of a national risk-stratified melanoma screening program for Australia (funded by a grant from the NHMRC), and if we find a cost-effective and feasible program design then it would be ideal to test that in a randomised controlled trial,’ she said.
JAMA Dermatol 2021; doi:10.1001/jamadermatol.2021.3884.