In a recent population-based cohort study published in JAMA Dermatology, researchers examined the association between melanoma-specific and all-cause mortality and different methods of melanoma detection.
The study involved 2,452 patients diagnosed with melanoma over 1 year, from October 23, 2006, to October 22, 2007, in the Melanoma Patterns of Care Study and followed until 2018 (mean [SD] length of follow-up, 11.9 [0.3] years) by utilizing linked mortality and cancer registry data. Of 3,932 recorded melanomas, data were available and evaluated for 2,452 subjects (62%; 1 per patient) with primary in situ (n = 291) or invasive (n = 2,161) cutaneous melanoma. Data were analyzed from March 2020 to January 2021. The average age at diagnosis was 65 years (range, 16-98 years), and 1,502 patients (61%) were men.
The primary objective of the study was to evaluate melanoma-specific and all-cause mortality associated with melanomas detected through routine skin checks, incidentally, or by the patient. A secondary aim was to examine patient, sociodemographic, and clinicopathologic factors associated with different modes of melanoma detection. The primary outcomes and measures were melanoma-specific mortality and all-cause mortality.
The researchers discovered that of the 2,452 patients included in the analysis, 858 (35%) had their melanoma detected at a routine skin check, 1,148 (47%) self-detected their melanoma, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion, and 153 (6%) reported "other" presentation. Also, routine skin-check detection of invasive melanomas was correlated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60; P <.001) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76; P <.001), adjusted for age and gender, compared with patient-detected melanomas. After adjustment for prognostic factors including ulceration and mitotic rate, the associations were 0.68 (95% CI, 0.44-1.03; P = .13), and 0.75 (95% CI, 0.63-0.90; P = .006), respectively.
The factors linked with higher odds of routine skin-check melanoma detection included being male (female vs. male, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), having previous melanoma (vs. none, OR, 2.36; 95% CI, 1.77-3.15; P <.001), having many moles (vs. not, OR, 1.39; 95% CI, 1.10-1.77; P = .02), being age 50 years or older (e.g., 50-59 years vs. <40 years, OR, 2.89; 95% CI, 1.92-4.34; P <.001), and living in nonremote areas (e.g., remote or very remote vs. major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003).
The researchers concluded that melanomas diagnosed via routine skin inspections were correlated with significantly lower all-cause mortality, but not melanoma-specific mortality, after adjusting for patient, sociodemographic, and clinicopathologic factors.
"A large randomized clinical trial is needed to provide definitive evidence that screening for skin cancer reduces melanoma-specific and all-cause mortality among people invited (vs not invited) to screen, but there are concerns about feasibility. Our findings could be used to estimate the sample size for a future trial," they concluded.
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Published November 5, 2021