Screening for reducing morbidity and mortality in malignant melanoma

Area of Science:

• Dermatology and Public Health
• Cancer Screening and Prevention

Background:

• Malignant melanoma screening aims for earlier detection to reduce morbidity and mortality, as prognosis correlates with lesion thickness.
• Potential harms include overdiagnosis, leading to unnecessary treatments and psychosocial distress from a cancer diagnosis.
• Balancing benefits against harms is crucial for any screening program; melanoma incidence is rising, but mortality remains stable.

Purpose of the Study:

• To assess the effects of malignant melanoma screening in the general population on morbidity and mortality.

Main Methods:

• Searched multiple databases (Cochrane Skin, CENTRAL, MEDLINE, Embase, LILACS) and trial registries up to May 2018.
• Included randomized controlled trials (RCTs), including cluster-RCTs, comparing screening to no screening in the general population.
• Excluded individuals with genetic predispositions or previous melanomas; primary outcomes were total mortality, overdiagnosis, and quality of life.

Main Results:

• Two studies (64,391 participants) were included, but neither reported on primary outcomes (mortality, overdiagnosis, psychosocial consequences).
• One study focused on skin self-examination intervention, the other was a pilot for population-based screening; both had high risk of bias.
• No published or unpublished data on prespecified outcomes were available; certainty of evidence could not be assessed.

Conclusions:

• Current RCT evidence neither supports nor refutes adult general population screening for malignant melanoma.
• Screening does not meet criteria for population program implementation due to insufficient evidence.
• A rigorously conducted RCT is needed to evaluate benefits and harms, including mortality, overdiagnosis, and psychosocial effects.