But does this mean GPs need to change their clinical practice?
Nearly a third of melanomas discovered during routine skin checks may not be harmful, new research from QIMR Berghofer suggests.
The observation studywho followed nearly 44,000 Queenslanders aged 40-69 with no history of melanoma for seven years found that detections were significantly higher in those who had their skin routinely examined by a doctor before enrolling in the study.
It concluded that people undergoing skin screening subsequently experience higher rates of biopsies and melanoma (especially melanoma in situ), 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 melanomas detected during skin checks “would never have come to light” had that person not been screened.
“It suggests that skin exams and biopsies pick up things that look and feel just like melanomas, but they don’t always behave that way or cause damage,” he said.
‘Melanoma can be a very dangerous form of cancer and our research does not diminish the importance of good prevention, screening and treatment.
“But it does open up some exciting research opportunities to improve the diagnosis and treatment of the disease.”
According to the authors of the paper, the results provide the first estimate of possible overdiagnosis of melanoma using individual patient data, and emphasize the need for further research to determine why some melanomas appear to remain dormant and undetected for long periods of time.
But if almost a third of the melanomas detected have not been found to be harmful, what does this mean for GPs who are regularly the first point of contact for people who want to have their skin checked?
for dr. Jeremy Hudson, president 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, this means that 29% of in-situ melanomas were ‘overdetected’, because in theory they would never cause harm. But practically we cannot say which 29% of melanomas are “not harmful”.
“We don’t know why some melanomas behave like this, for example whether they are immune or genetic factors… [so] this research makes no difference to skin checks or screening at the moment.’
One result the researchers hope will emerge from this study is the development of more accurate diagnostic tools that can spare patients 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 that they have a potentially deadly cancer and undergo constant checkups and scans. It’s a life-changing event,” he said.
Fortunately, most people with melanoma in Australia can expect an excellent prognosis, as doctors in this country are world leaders in detecting and treating this disease.
‘If we can find a way to distinguish the melanomas with a good prognosis from the very unpleasant melanomas, we may be able to give patients better information about their condition and better treatment options.
“It would also help ease the burden on the health care system, as the treatment of melanoma is very, very expensive.”
QIMR Berghofer’s QSkin Study Team will reportedly continue the research by investigating whether there are certain genes that influence the behavior of melanoma and the development of more serious diseases.
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