Caroline G Watts1,2, Kirstie McLoughlin1,3, Chris Goumas1, Cathelijne H van Kemenade1, Joanne F Aitken4,5, H Peter Soyer6,7, Pablo Fernandez Peñas8,9, Pascale Guitera10,11,12, Richard A Scolyer10,11,13, Rachael L Morton10,14, Scott W Menzies11,12, Michael Caruana1,3, Yoon Jung Kang1,3, Graham J Mann10,15,16, Annette H Chakera17,18, Christine M Madronio19, Bruce K Armstrong20, John F Thompson10,11, Anne E Cust1,10. 1. The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia. 2. Surveillance, Epidemiology and Research Program, Kirby Institute, University of New South Wales, Sydney, Australia. 3. Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia. 4. School of Public Health, The University of Queensland, Brisbane, Australia. 5. Cancer Council Queensland, Brisbane, Australia. 6. The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia. 7. Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia. 8. Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 9. Department of Dermatology, Westmead Hospital, Westmead, Sydney, Australia. 10. Melanoma Institute Australia, The University of Sydney, Sydney, Australia. 11. Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 12. Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia. 13. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, Australia. 14. National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 15. Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia. 16. John Curtin School of Medical Research, Australian National University, Canberra, Australia. 17. Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen, Denmark. 18. Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark. 19. Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 20. Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Abstract
IMPORTANCE: Early melanoma diagnosis is associated with better health outcomes, but there is insufficient evidence that screening, such as having routine skin checks, reduces mortality. OBJECTIVE: To assess melanoma-specific and all-cause mortality associated with melanomas detected through routine skin checks, incidentally or patient detected. A secondary aim was to examine patient, sociodemographic, and clinicopathologic factors associated with different modes of melanoma detection. DESIGN, SETTING, AND PARTICIPANTS: This prospective, population-based, cohort study included patients in New South Wales, Australia, who were diagnosed with melanoma over 1 year from October 23, 2006, to October 22, 2007, in the Melanoma Patterns of Care Study and followed up until 2018 (mean [SD] length of follow-up, 11.9 [0.3] years) by using linked mortality and cancer registry data. All patients who had invasive melanomas recorded at the cancer registry were eligible for the study, but the number of in situ melanomas was capped. The treating doctors recorded details of melanoma detection and patient and clinical characteristics in a baseline questionnaire. Histopathologic variables were obtained from pathology reports. Of 3932 recorded melanomas, data were available and analyzed for 2452 (62%; 1 per patient) with primary in situ (n = 291) or invasive (n = 2161) cutaneous melanoma. Data were analyzed from March 2020 to January 2021. MAIN OUTCOMES AND MEASURES: Melanoma-specific mortality and all-cause mortality. RESULTS: A total of 2452 patients were included in the analyses. The median age at diagnosis was 65 years (range, 16-98 years), and 1502 patients (61%) were men. A total of 858 patients (35%) had their melanoma detected during a routine skin check, 1148 (47%) self-detected their melanoma, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion, and 153 (6%) reported "other" presentation. Routine skin-check detection of invasive melanomas was associated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60; P < .001) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76; P < .001), adjusted for age and sex, compared with patient-detected melanomas. After adjusting for prognostic factors including ulceration and mitotic rate, the associations were 0.68 (95% CI, 0.44-1.03; P = .13), and 0.75 (95% CI, 0.63-0.90; P = .006), respectively. Factors associated with higher odds of routine skin-check melanoma detection included being male (female vs male, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), having previous melanoma (vs none, OR, 2.36; 95% CI, 1.77-3.15; P < .001), having many moles (vs not, OR, 1.39; 95% CI, 1.10-1.77; P = .02), being 50 years or older (eg, 50-59 years vs <40 years, OR, 2.89; 95% CI, 1.92-4.34; P < .001), and living in nonremote areas (eg, remote or very remote vs major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003). CONCLUSIONS AND RELEVANCE: In this cohort study, melanomas diagnosed through routine skin checks were associated with significantly lower all-cause mortality, but not melanoma-specific mortality, after adjustment for patient, sociodemographic, and clinicopathologic factors.
IMPORTANCE: Early melanoma diagnosis is associated with better health outcomes, but there is insufficient evidence that screening, such as having routine skin checks, reduces mortality. OBJECTIVE: To assess melanoma-specific and all-cause mortality associated with melanomas detected through routine skin checks, incidentally or patient detected. A secondary aim was to examine patient, sociodemographic, and clinicopathologic factors associated with different modes of melanoma detection. DESIGN, SETTING, AND PARTICIPANTS: This prospective, population-based, cohort study included patients in New South Wales, Australia, who were diagnosed with melanoma over 1 year from October 23, 2006, to October 22, 2007, in the Melanoma Patterns of Care Study and followed up until 2018 (mean [SD] length of follow-up, 11.9 [0.3] years) by using linked mortality and cancer registry data. All patients who had invasive melanomas recorded at the cancer registry were eligible for the study, but the number of in situ melanomas was capped. The treating doctors recorded details of melanoma detection and patient and clinical characteristics in a baseline questionnaire. Histopathologic variables were obtained from pathology reports. Of 3932 recorded melanomas, data were available and analyzed for 2452 (62%; 1 per patient) with primary in situ (n = 291) or invasive (n = 2161) cutaneous melanoma. Data were analyzed from March 2020 to January 2021. MAIN OUTCOMES AND MEASURES: Melanoma-specific mortality and all-cause mortality. RESULTS: A total of 2452 patients were included in the analyses. The median age at diagnosis was 65 years (range, 16-98 years), and 1502 patients (61%) were men. A total of 858 patients (35%) had their melanoma detected during a routine skin check, 1148 (47%) self-detected their melanoma, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion, and 153 (6%) reported "other" presentation. Routine skin-check detection of invasive melanomas was associated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60; P < .001) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76; P < .001), adjusted for age and sex, compared with patient-detected melanomas. After adjusting for prognostic factors including ulceration and mitotic rate, the associations were 0.68 (95% CI, 0.44-1.03; P = .13), and 0.75 (95% CI, 0.63-0.90; P = .006), respectively. Factors associated with higher odds of routine skin-check melanoma detection included being male (female vs male, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), having previous melanoma (vs none, OR, 2.36; 95% CI, 1.77-3.15; P < .001), having many moles (vs not, OR, 1.39; 95% CI, 1.10-1.77; P = .02), being 50 years or older (eg, 50-59 years vs <40 years, OR, 2.89; 95% CI, 1.92-4.34; P < .001), and living in nonremote areas (eg, remote or very remote vs major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003). CONCLUSIONS AND RELEVANCE: In this cohort study, melanomas diagnosed through routine skin checks were associated with significantly lower all-cause mortality, but not melanoma-specific mortality, after adjustment for patient, sociodemographic, and clinicopathologic factors.
Authors: Mathias Seviiri; Richard A Scolyer; D Timothy Bishop; Julia A Newton-Bishop; Mark M Iles; Serigne N Lo; Johnathan R Stretch; Robyn P M Saw; Omgo E Nieweg; Kerwin F Shannon; Andrew J Spillane; Scott D Gordon; Catherine M Olsen; David C Whiteman; Maria Teresa Landi; John F Thompson; Georgina V Long; Stuart MacGregor; Matthew H Law Journal: J Transl Med Date: 2022-09-05 Impact factor: 8.440
Authors: Soma Jobbagy; Kristine M Chaudet; Matthew Gayhart; Veronica E Klepeis; Genevieve Boland; Hensin Tsao; Lyn M Duncan Journal: JAAD Int Date: 2022-08-31