Melanoma Severity at Presentation and Prior Skin Cancer Screening: A Survey Study of Surgical Oncology Patients

The effectiveness of population-based melanoma screening remains uncertain. However, most melanomas continue to present outside of skin cancer screening, underscoring the need to better understand and serve unscreened populations.

All patients presenting to surgical oncology at a rural tertiary referral center with newly diagnosed invasive melanoma from April 2020 to January 2021 were administered a survey to assess history of a skin cancer screening examination and risk factors for melanoma. Additional demographic and clinical characteristics were abstracted from the electronic medical record. The exposure of interest was dermatological skin cancer screening examination within the past 12 months. The primary outcome was pathological tumor staging. This was assessed using ordinal logistic regression.

Forty patients presented to surgical oncology with a newly diagnosed melanoma. Thirty patients (75%) reported no skin cancer screening examination within the past 12 months. Patients who had screening were more likely to report prior indoor tanning use (70% [7/10] vs. 23% [7/30], OR 7.20, 95% CI 1.25-55.24, p = 0.02) and a personal history of nonmelanoma skin cancer (60% [6/10] vs. 13% [4/30], OR 9.00, 95% CI 1.44-68.66 p = 0.007). Remaining baseline characteristics were similar. Patients who had screening presented with a significantly lower T stage (OR 0.24, 95% CI 0.05-0.91, p = 0.04). No patients who had screening presented with lymph node metastasis compared with 20% of patients (6/30) who did not undergo screening. No patients in our cohort presented with distant metastasis.

Most melanomas presenting to surgical oncology occurred in patients without recent screening and were more advanced at presentation. These findings highlight the importance of maintaining rapid access to dermatologic evaluation for patients who do not participate in routine screening, as they represent the majority of clinically significant melanoma presentations.