QWill the NEJM article regarding the rapid rise of cutaneous melanoma diagnoses change the way you practice?

A
Gabriela Maloney, DO

Gabriela Maloney, DO

Dermatologist
Forefront Dermatology
Brookfield, WI

The number of cutaneous melanoma diagnoses has increased by 6 times in the past 40 years while tThe number of cutaneous melanoma diagnoses has increased by 6 times in the past 40 years while the same increase has not been seen in non-cutaneous melanomas1. The largest increase in incidence favors melanomas in situ, and melanoma mortality has stayed generally stable. The relative risk between UV radiation and melanoma is approximately 2, much less than the 6-fold increase in incidence2, which begs for an additional explanation. The authors believe that the rise in cutaneous melanomas results from increase in diagnostic scrutiny. This includes more screening examinations, decreased biopsy thresholds and pathological thresholds, and lack of strict pathological criteria3. In a post-COVID era of financial strain they argue for reassessment of melanoma screening. 

Immunotherapy has brought incredible advances in melanoma treatment that were unimaginable a few years ago, and with melanoma still being one of the most common cancers in the young population I do believe patient education is of utmost importance. It is our job as dermatologists to educate about skin cancer risk factors, importance of sun protection and signs of skin cancers. Yes, the number of skin examinations and biopsies has risen, but in times of such costly health care, I also see that patients are much more conscious of how expensive procedures can be and are seeking more education on the matter, often only consenting to procedures if they truly have a major concern.

In my opinion we still need more time and data to determine whether widespread routine skin cancer screenings should continue to exist. Until then I will continue to offer and recommend screenings for my high risk patients, those with history of skin cancers and/or family history of malignant melanoma, and will continue to see and educate the low risk patients who wish to have their skin checked due to lesions of concern.

References:

  1. National Cancer Institute. Cancer statistics review (CSR) 1975-2016
  2. Boniol M. et.al. Cutaneous melanoma attributable to sun bed use: systematic review and meta analysis. BMJ 2012;345:e4757
  3. Welch H. et.al. The rapid rise in cutaneous melanoma diagnoses. NEJM 2021;384:72-9