Melanomas diagnosed during routine skin checks are associated with significantly lower all-cause mortality, but not melanoma-specific mortality, according to study findings published in JAMA Dermatology.
The Melanoma Patterns of Care Study included patients who were diagnosed with a histopathologically confirmed primary in situ or invasive cutaneous melanoma in Australia from October 23, 2006, to October 22, 2007. The patients were followed up for diagnosis of new primary melanomas and death from any cause for a mean (SD) of 11.9 (0.3) years.
Data were available for 2452 patients—35% of patients had their melanoma detected at a routine skin check, 47% self-detected their melanoma, 12% had their melanoma detected incidentally when checking another skin lesion, and 6%reported “other” presentation. Participants had a median age at diagnosis of 65 years (range, 16-98 years), and 61% were men. Among the men, 39% of melanomas were detected on a routine skin check, compared with 29% for women.
During the follow-up, 162 deaths (7%) occurred from melanoma and 604 deaths (26%) occurred from other causes in the 2299 patients who were included in the survival analysis. Invasive melanoma detected during a routine skin check was associated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76) vs patient-detected melanomas in regression models that were adjusted for age and sex.
After further adjustment for mitotic rate and ulceration, the association was not statistically significant for melanoma-specific mortality (subhazard ratio, 0.68; 95% CI, 0.44-1.03) but remained statistically significant for all-cause mortality (hazard ratio, 0.75; 95% CI, 0.63-0.90).
Higher odds were found for melanoma being detected during a routine skin check for men (women vs men, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), participants aged 50 years and older (eg, 50-59 years vs <40 years, OR, 2.89; 95% CI, 1.92-4.34; P < .001), those with a previous melanoma (vs none, OR, 2.36; 95% CI, 1.77-3.15; P < .001), those with many moles (vs without, OR, 1.39; 95% CI, 1.10-1.77; P = .02), and those who lived in nonremote areas (eg, remote or very remote vs major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003).
Among several study limitations noted by the investigators, the results may be less generalizable to countries that have a lower skin cancer incidence. Also, causality was not determined owing to the observational design, and information was not available regarding how other melanomas were detected in patients who developed multiple primary melanomas during the follow-up.
Based on their study findings, the researchers suggested that “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.”
Disclosure: Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Watts CG, McLoughlin K, Goumas C, et al. Association between melanoma detected during routine skin checks and mortality. JAMA Dermatol. Published online November 3, 2021. doi:10.1001/jamadermatol.2021.3884