Researchers advocate for promotion of skin self-examination for early melanoma detection

Key takeaways:

• 62.5% of 128 patients were diagnosed with a melanoma less than 1 mm thick after having conducted skin self-examinations (SSE).
• The U.S. Preventive Services Task Force should promote SSE.

Skin self-examination is a viable secondary prevention method for the early detection of primary melanoma and should be promoted to patients, according to an article published in the Journal of the American Academy of Dermatology.

While reducing melanoma mortality by removing early-stage melanomas has long been a goal for dermatologists, the authors of this article believe that physician-led screenings of asymptomatic adults have done little to achieve this goal.

This opinion from the authors coincides with the U.S. Preventive Services Task Force’s (USPSTF) recent statement, released in April 2023, which said that there is not enough evidence to recommend physician-led skin cancer screenings in patients without signs and symptoms.

David Polsky

Other developed therapies, however, have been able to significantly lower the mortality of melanomas.

“We are fortunate to have wonderfully effective systemic therapies for patients with metastatic melanoma, and many patients are cured with these drugs,” David Polsky, MD, PhD, of the Ronald O. Perelman department of dermatology and Perlmutter Cancer Center at NYU Langone Health, told Healio. “For that reason, prevention studies should no longer focus on death from melanoma as their endpoint since it can be affected positively by these new treatments. Instead, the effectiveness of prevention studies should be based on reductions in tumor thickness at diagnosis. Thinner tumors require less complicated, less costly care. This endpoint is directly related to the success of prevention efforts.”

According to Polsky, one of those secondary prevention methods must include skin self-examination (SSE).

The American Academy of Dermatology and the American Cancer Society have also recommended that patients perform SSE. The USPSTF, however, disagrees. In 2018, insufficient evidence that these examinations reduced mortality led the task force to not endorse SSE.

Shortly following the USPSTF’s statement, a study emerged showing that of 128 patients that performed SSE in the year prior to a melanoma diagnosis, 62.5% were diagnosed with a melanoma less than 1 mm thick, whereas 30% had a melanoma measuring more than 4 mm thick (P = .022).

“These and other similar findings provide ample evidence that SSE is associated with decreased tumor thickness, and by extension, reduced melanoma morbidity,” Polsky and colleagues wrote.

Many practitioners often worry that promoting SSE will cause potential harms such as increased health care visits and procedures for benign melanomas; however, the authors believe that these costs are marginal to that of treating advanced melanoma.

“We would like to see the USPSTF reconsider their approach to evaluating melanoma prevention studies,” Polsky told Healio, further explaining that a recommendation from the task force promoting SSE would support efforts to increase melanoma awareness and individual engagement in personal health care.