Rationale
Australia has one of the highest incidences of melanoma in the world (40-60/100,000), behind breast, prostate and colorectal cancer. It is more common than lung cancer but more readily curable. Treatment of early melanomas is often curative, as opposed to those lesions which invade deeply or spread to regional nodes. Self examination is often not done, or if done it is not performed completely due to difficulties with self examination of the back and genital areas.
Arguments against screening include a likely increased rate of biopsies of benign lesions and resulting cosmetic problems, lack of resources for skin screening, and a lack of randomised evidence.
Evidence
There are no randomised trials in melanoma screening.
- An observation German study was instituted in part of the country. 5% of biopsies in older men, and < 2% of biopsies in younger men, were positive for melanoma. 90% of melanomas were < 1 mm (T1). There was an increased incidence of melanoma during the period, but the mortality from melanoma within the region dropped to 50% of the previous levels and when compared to the rest of Germany. Germany now has a biannual screening program for adults over 35.
- A randomised Australian trial that was not completed due to funding demonstrated the feasability of a community melanoma screening program
Observational studies suggest that cancers picked up during screening are usually smaller and more likely to be cured; however the potential for overdiagnosis has not been established.
Implementation
It seems unlikely that a screening trial for melanoma will be undertaken. The results from Germany are intriguing, but results are still early. If the mortality from melanoma in Germany falls significantly with the introduction of a screening program, there may be increased emphasis on its introduction in Australia. For now, screening for melanoma should be done in select patients with family history or other high risk features.
