Visual Screening for Malignant Melanoma

Losina, Elena; Walensky, Rochelle P.; Geller, Alan C.; Beddingfield, Frederick C.; Wolf, Lindsey L.; Gilchrest, Barbara A.; Freedberg, Kenneth A.

doi:10.1001/archderm.143.1.21

Cited by 137 publications

(102 citation statements)

References 34 publications

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“…46 In a cost-effectiveness analysis for melanoma screening, Losina et al found that one-time melanoma screening of the US general population at age 50 years and screening of siblings of patients with melanoma every 2 years by dermatologists have costeffectiveness ratios of $10,100/QALYs gained and $35,500/QALYs gained, respectively. 47 These ratios are comparable to those for other types of cancer screening, including breast, cervical, and colorectal cancers, all of which are recommended by the USPSTF. However, no randomized prospective melanoma screening trial exists.…”

Section: Basic Factors In Early Diagnosissupporting

confidence: 53%

The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs

Rigel

Russak

Friedman

2010

CA: A Cancer Journal for Clinicians

336

274

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Early detection of malignant melanoma remains the key factor in lowering mortality from this cancer. Recognizing the importance of this issue 25 years ago, our group at New York University published in CA: A Cancer Journal for Clinicians the mnemonic "ABCD" to facilitate the early diagnosis of melanoma. Studies have demonstrated the usefulness of this paradigm in enhancing early melanoma diagnosis as a part of clinical examinations, mass screenings, and public education programs. Approaches to melanoma diagnosis have dynamically evolved during the ensuing quarter century. In the 1990s, dermoscopy enabled the recognition of new subsurface features to differentiate between malignant and benign pigmented lesions. During the last decade, new computer-based technologies have improved diagnostic sensitivity and specificity and may result in optimizing lesion selection for biopsy and pathology review. Despite all of the advances in melanoma diagnosis, timely recognition, detection, and rapid treatment of melanoma remain critical. Although pathologic examination remains the gold standard for diagnosis, this cancer has the potential to be diagnosed through noninvasive approaches because of its cutaneous location. From the development of the ABCDs through current attempts that use complex computer algorithms and genetic markers, a clinician's ability to detect melanoma in its earliest form has been augmented. However, a "good clinical eye" is still fundamental to selecting the lesions for evaluation among the sea of those that are prevalent. As current approaches are refined and new techniques are developed, the improved ability to diagnose this cancer will hopefully enhance reaching the goal of reducing melanoma mortality. CA Cancer J Clin 2010;60:301-316.

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Section: Basic Factors In Early Diagnosissupporting

confidence: 53%

The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs

Rigel

Russak

Friedman

2010

CA: A Cancer Journal for Clinicians

336

274

View full text Add to dashboard Cite

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“…Nevertheless, when this efficacy has to be translated in effectiveness and valued in terms of QALYs for a CEA, one of the main obstacles is the lack of data with which to assess the evolution of diagnosed melanomas [28]. The authors of this CEA used a simple assessment suggested by Losina in a previously published CEA of melanoma screening [29]. Based on experts' opinion, they predicted a 10% progression rate of melanoma from one stage to another annually.…”

Section: Periodsmentioning

confidence: 99%

Cost-effectiveness analysis in melanoma detection: A transition model applied to dermoscopy

Tromme

Legrand

Devleesschauwer

et al. 2016

European Journal of Cancer

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Aim: The main aim of this study is to demonstrate how our melanoma disease model (MDM) can be used for cost-effectiveness analyses (CEAs) in the melanoma detection field. In particular, we used the data of two cohorts of Belgian melanoma patients to investigate the cost-effectiveness of dermoscopy. Methods: A MDM, previously constructed to calculate the melanoma burden, was slightly modified to be suitable for CEAs. Two cohorts of patients entered into the model to calculate morbidity, mortality and costs. These cohorts were constituted by melanoma patients diagnosed by dermatologists adequately, or not adequately, trained in dermoscopy. Effectiveness and costs were calculated for each cohort and compared. Effectiveness was expressed in (2016) 38e45 quality-adjusted life years (QALYs), a composite measure depending on melanoma-related morbidity and mortality. Costs included costs of treatment and follow-up as well as costs of detection in non-melanoma patients and costs of excision and pathology of benign lesions excised to rule out melanoma. Results: The result of our analysis concluded that melanoma diagnosis by dermatologists adequately trained in dermoscopy resulted in both a gain of QALYs (less morbidity and/or mortality) and a reduction in costs. Conclusion: This study demonstrates how our MDM can be used in CEAs in the melanoma detection field. The model and the methodology suggested in this paper were applied to two cohorts of Belgian melanoma patients. Their analysis concluded that adequate dermoscopy training is cost-effective. The results should be confirmed by a large-scale randomised study. ª

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“…This is not dissimilar to the 8Á7% of the population identified as 'worryingly high risk' or 'very increased risk' in the study by Jackson et al 25 While such strategies are likely to increase local referral rates and dermatology workload, and there is a U.K. shortage of dermatologists, a recent review suggests that melanoma early detection programmes might be cost-effective 14 if targeted at high-risk populations such as older men 32 or those with a family history of melanoma. 12 It is likely that identifying higher-risk individuals using a risk score would be more cost-effective, but further studies are needed to confirm this and to determine the most cost-effective intervals for surveillance amongst those at different levels of risk. The finding that collecting risk information in waiting rooms in general practices across the U.K. using tablet computers was both feasible and acceptable to patients also has implications beyond screening for melanoma.…”

Section: Discussionmentioning

confidence: 99%

Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey

et al. 2016

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SummaryBackground Melanoma incidence is rising rapidly worldwide among white populations. Defining higher-risk populations using risk prediction models may help targeted screening and early detection approaches. Objectives To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care. Methods We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model. Results Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17Á15 AE 8Á51, with small regional differences [lower in England compared with Scotland (P = 0Á001) and Wales (P < 0Á001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma. Conclusions Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.

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Visual Screening for Malignant Melanoma

Cited by 137 publications

References 34 publications

The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs

The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCDs

Cost-effectiveness analysis in melanoma detection: A transition model applied to dermoscopy

Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey

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