Researchers in Australia found higher rates of melanoma diagnosis, particularly in situ melanoma, and skin biopsies among people who had undergone skin screenings. These findings were reported in a study recently published in the British Journal of Dermatology.
Early detection has been touted as a method to decrease morbidity and mortality associated with cutaneous melanoma, the researchers explained in their report. However, greater surveillance could result in overdiagnosis of indolent melanomas that do not have lethal potential, with patients possibly experiencing overtreatment and other effects.
Using a population-based registry, the researchers randomly identified adults aged 40 to 69 years residing in Queensland, Australia, to participate in this prospective study, called the QSkin Study. Included participants did not have a previous history of melanoma. Participants completed a survey at baseline regarding melanoma risk factors and any history of skin screening by physicians during the prior 3 years. The researchers examined participants’ data in a cancer registry to evaluate incidence of melanoma diagnoses in years 2 to 7 after enrollment and data from Australia’s Medical Benefits Schedule (MBS) to evaluate biopsy rates.
A total of 38,682 participants completed a baseline survey, with 35,825 consenting to use of their data from the MBS. Most participants (73%) who completed the baseline survey indicated they had undergone skin screenings performed by physicians during the 3 years prior. Among the participants included in the analysis of MBS data, 9% underwent at least 1 skin biopsy during the first year of follow-up.
A total of 967 participants received a new diagnosis of at least 1 melanoma in the follow-up period. This included 316 patients with invasive melanoma only, 586 with in situ melanoma only, and 65 with both invasive and in situ melanomas.
In an analysis adjusted for known risk factors, participants who had undergone skin screenings showed a higher rate of melanoma (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.02-1.63) compared with participants who did not report skin screenings. Screened participants also appeared more likely to later undergo a skin biopsy (aHR, 1.85; 95% CI, 1.69-2.04) than unscreened participants.
Skin screening was associated with a higher risk of an in situ melanoma diagnosis (aHR, 1.45; 95% CI, 1.09-1.92), but not a higher risk of an invasive melanoma diagnosis (aHR, 1.05; 95% CI, 0.72-1.54). Biopsy in the first year after baseline was associated with a higher risk of melanoma diagnosis (aHR, 1.53; 95% CI, 1.23-1.89) compared with no biopsy. It also was linked to a greater risk of undergoing further biopsies (aHR, 2.64; 95% CI, 2.46-2.84).
Data from this study support the hypothesis that overdetection may be occurring with skin screenings. “Whether detecting those additional melanomas confers a mortality benefit remains an open question,” the researchers concluded.
Whiteman DC, Olsen CM, MacGregor S, et al; for the QSkin Study. The effect of screening on melanoma incidence and biopsy rates. Br J Dermatol. Published online May 9, 2022. doi:10.1111/bjd.21649