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Skin checks detecting high proportion of ‘not harmful’ melanomas
But does this mean GPs should change their clinical practice?
New research indicates up to 29% of the melanomas detected during skin checks may ‘never have come to light’ if that person had not been screened.
Nearly one third of melanomas detected during routine skin checks may not be harmful, new research out of QIMR Berghofer suggests.
The observational study, which tracked nearly 44,000 Queenslanders aged 40–69 years with no prior history of melanoma over seven years, found detections were significantly higher among those who had routinely had their skin examined by a doctor before enrolling in the study.
It concluded that people who undergo skin screening subsequently experience higher rates of biopsies and melanoma (especially in situ melanoma), even after adjusting for all known risk factors, ‘consistent with overdiagnosis’.
Professor David Whitemen, who led the study, said the findings indicate that up to 29% of the melanomas detected during skin checks may ‘never have come to light’ if that person had not been screened.
‘It suggests that skin examinations and biopsies are picking up things that look and feel just like melanomas, but they don’t always behave like them or cause harm,’ he said.
‘Melanoma can be a very dangerous cancer and our study does not lessen the importance of good prevention, screening and treatment at all.
‘But it does open up some exciting research possibilities to improve diagnosis and treatment of the disease.’
According to the paper’s authors, the results offer the first estimate of potential melanoma overdiagnosis using individual patient data, and highlight the need for further research to determine why some melanomas appear to stay dormant and undetected for long periods of time.
But if nearly one third of detected melanomas may not have proved harmful, what does this mean for GPs who are regularly the first port of call for people wanting to have their skin checked?
For Dr Jeremy Hudson, Chair of RACGP Specific Interests Dermatology, the message is ‘keep calm and carry on’.
‘Overdiagnosis is a broad term that is difficult to define,’ he told newsGP.
‘In this context it means 29% of the in-situ melanomas were “overdetected” as theoretically they were never going to cause harm. But practically, we can’t tell which 29% of melanomas are “not harmful”.
‘We don’t know why some melanomas behave this way, for example, whether it is immune or genetic factors … [so] this study makes no difference to skin checks or screening at this time.’
One outcome the researchers hope will stem from this study is the development of more accurate diagnostic tools that can spare patients from the anxiety associated with a melanoma diagnosis.
Professor Whiteman says these more accurate tools would benefit patients, doctors and the health system.
‘Patients diagnosed with melanoma have to live with the fact they have a potentially fatal cancer, and endure ongoing check-ups and scans. It’s a life-changing event,’ he said.
‘Fortunately, most people diagnosed with melanoma in Australia can expect an excellent prognosis, as doctors in this country are world leaders in the detection and treatment of this disease.
‘If we can find a way to distinguish the melanomas with a good prognosis from the very nasty melanomas, we might be able offer patients better information about their condition and more appropriate treatment options.
‘It would also help alleviate pressure on the healthcare system as melanoma treatment is very, very costly.’
QIMR Berghofer’s QSkin Study Team will reportedly continue the research by investigating whether there are particular genes that influence the behaviour of melanoma and the development of more serious disease.
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