According to an article published in the Journal of the American Academy of Dermatology, skin self-examination is a viable secondary prevention method for the early detection of primary melanoma and should be promoted to patients.1
While removing early-stage melanomas to reduce melanoma mortality has long been a goal for dermatologists, physician-led screenings of asymptomatic adults have done little to achieve this goal. Furthermore, also the U.S. Preventive Services Task Force’s (USPSTF) statement (released in April 2023), specified that there is not enough evidence to recommend physician-led skin cancer screenings in patients without signs/symptoms. However, other developed therapies 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,” said David Polsky, MD, PhD, of the Ronald O. Perelman Department of Dermatology and Perlmutter Cancer Center at NYU Langone Health. “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 tumour thickness at diagnosis. Thinner tumours require less complicated, less costly care. This endpoint is directly related to the success of prevention efforts.”
One of those secondary prevention methods should include skin self-examination (SSE). While the American Academy of Dermatology and the American Cancer Society recommend that patients perform SSE, the USPSTF disagrees. In 2018, the USPSTF chose not to endorse SSE due to insufficient evidence that these examinations reduced mortality. However, shortly thereafter, 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 of less than 1 mm thick, while 30% had a melanoma measuring >4 mm thick (p= 0.022). “These and other similar findings provide ample evidence that SSE is associated with decreased tumour thickness, and by extension, reduced melanoma morbidity,” Polsky et al. wrote.
Numerous practitioners worry that promoting SSE will cause potential harm, i.e. increased healthcare visits and procedures for benign melanomas. However, these costs are marginal compared to that of treating advanced melanoma. “We would like to see the USPSTF reconsider their approach to evaluating melanoma prevention studies,” Polsky stated, explaining that a recommendation from the task force promoting SSE would support efforts to increase melanoma awareness.2
CONCLUSIONS
Skin self-examination is associated with a decreased tumour thickness and, by extension, will lead to reduced melanoma morbidity. Therefore, the USPSTF should reconsider their previous statement and should promote SSE.
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