Association between risk factors and detection of cutaneous melanoma in the setting of a population-based skin cancer screening

Abstract

Early detection is considered to improve the prognosis of cutaneous melanoma. The value of population-based screening for melanoma, however, is still controversial. The aim of this study was to evaluate the predictive power of established risk factors in the setting of a population-based screening and to provide empirical evidence for potential risk stratifications. We reanalyzed data (including age, sex, risk factors, and screening results) of 354 635 participants in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN)project conducted in the German state of Schleswig-Holstein (2003-2004). In multivariable analysis, atypical nevi [odds ratio (OR): 17.4; 95% confidence interval (CI): 14.4-20.1], personal history of melanoma (OR: 5.3; 95% CI: 3.6-7.6), and multiple (≥40) common nevi (OR: 1.3; 95% CI: 1.1-1.6) were associated with an increased risk of melanoma detection. Family history and congenital nevi were not significantly associated with melanoma detection in the SCREEN. The effects of several risk-adapted screening strategies were evaluated. Hypothesizing a screening of individuals aged more than or equal to 35 years, irrespective of risk factors (age approach), the number needed to screen is 559 (95% CI: 514-612), whereas a screening of adults (aged ≥20) with at least one risk factor (risk approach) leads to a number needed to screen of 178 (95% CI: 163-196). Converted into one screen-detected melanoma, the number of missed melanomas is 0.15 (95% CI: 0.12-0.18) with the age approach and 0.22 (95% CI: 0.19-0.26) with the risk approach. The results indicate that focusing on individuals at high risk for melanoma may improve the cost-effectiveness and the benefit-to-harm balance of melanoma screening programs.

Risk Factors of Subsequent Primary Melanomas in Austria

“…Besides the number of nevi and a positive family history of melanoma, no other risk factor of subsequent melanoma is well known except a previous diagnosis of melanoma itself. 7,8 The frequency of subsequent melanomas was reported to range from 8.2% of previously diagnosed melanoma in European countries to 23% in continents with a more intense ambient UV radiation. 15, [22][23][24][25][26][27][28] These numbers reflect the complex interplay between internal (ie, inherited) and external risk factors, mainly UV radiation, as the base for melanoma development in general.…”

Comparison of patient pathways in the early detection of skin cancer – a claims data analysis

“…In participants aged 20 years or older, the NED was 27 for CM, 8 for basal cell carcinoma (BCC), and 41 for squamous cell carcinoma (SCC) [5–7]. When only participants from the age of 35 were included, corresponding to the age group entitled to benefit from the rSCS program, the NED for CM was lower compared to all SCREEN participants (22 vs. 27) [24]. Although all studies described above were conducted in Germany, they resulted in a lower NED compared to our findings (NED 23–42 for CM and 5 for NMSC).…”

Cost-effectiveness of a melanoma screening programme using whole disease modelling

“…As Hu¨bner et al point out, focusing on individuals at high risk for melanoma may also improve the benefit-to-harm balance of melanoma screening programmes. 39 The screening programme in our study, in accordance with the SCREEN project conducted in Northern Germany, includes a recruitment scheme based on explanatory images that should help people identify a suspect lesion, and so the invitation for screening tends to recruit potentially higher risk individuals.…”