Insufficient Evidence to Support Broad Screening for Malignant Melanoma in Adults

By Will Boggs MD

July 30, 2019

NEW YORK (Reuters Health) - There is insufficient evidence to assess the benefits and harms of adult screening for malignant melanoma in the general population, according to a new Cochrane review.

Many countries have programs that screen for malignant melanoma, but it remains unclear whether such programs reduce morbidity and mortality or cause undue harm resulting from overdiagnosis or unnecessary treatment.

Dr. Minna Johansson from Cochrane Sweden, in Uddevalla, and colleagues set out to assess the effects on morbidity and mortality of screening for malignant melanoma in the general population. But in the only two studies that met their inclusion criteria, there was no information on the effects of screening on total deaths, overdiagnosis from screening, participant quality of life, deaths from skin cancer, or false-positive/-negative rates.

One U.S. study of an intervention developed to increase the rate of performance of thorough skin self-examination reported on none of these outcomes, and one Australian study of population-based screening for malignant melanoma was never carried out due to lack of funding, the team notes June 3 in the Cochrane Database of Systematic Reviews.

"Adult general population screening for malignant melanoma is not supported or refuted by current evidence from randomized controlled trials," the authors conclude. "It therefore does not fulfill accepted criteria for implementation of population screening programs."

"This review did not investigate the effects of screening people with a history of malignant melanoma or in people with a genetic disposition for malignant melanoma (e.g., familial atypical mole and melanoma syndrome)," they add. "To determine the benefits and harms of screening for malignant melanoma, a rigorously conducted randomized trial is needed, which assesses overall mortality, overdiagnosis, psychosocial consequences, and resource use."

Dr. Richard A. Shellenberger from St. Joseph Mercy Hospital Ann Arbor, in Michigan, who has researched melanoma screening and ways to improve it, told Reuters Health by email, "Although the evidence does not support widespread screening of the general population, this does not equate to doing nothing. Examining the skin in high-risk groups is the only method to detect melanoma at its earliest stage with the best outcomes."

"Physicians should also educate patients on avoiding sunburns and the dangers of sun exposures," he said. "The evidence level is grade C for sunscreen preventing melanoma. We should not give up on examining the skin based on this report, especially since we have seen a decline in melanoma incidence and mortality."

"Asking patients about sunburns and family history of melanoma is an easy method of risk stratification for patients who should have skin examinations," Dr. Shellenberger said. "The most important question may be the change in nevi or moles. Any nevus which is evolving should be examined."

He added, "A study done by the University of Pittsburgh showed a 79% increase in melanoma diagnosis one year after a group of primary-care physicians (PCPs) took a 90-minute online course in skin cancer identification compared to a group of PCPs who did not take the course. Primary-care physicians have the power to make an impact for melanoma outcomes."

Dr. Johansson was not available for comments.


Cochrane Database Syst Rev 2019.