Evidence builds for targeted melanoma screening: ACD

Skin cancers

By Geir O'Rourke

16 Jan 2024

Evidence is mounting for Australia to institute a targeted melanoma screening program and the time has come for investment in formal cost-benefit analysis, the Australasian College of Dermatologists says.

Nevertheless, the case remains inadequate to support any population-wide scheme because of insufficient confirmation of a mortality benefit, the ACD has concluded.

The college has put forward an overview of the evidence around screening in a new position statement on the topic, which notes incidence rates continue to climb for melanoma, currently the most common cancer in Australians aged 15-39 years.

And despite treatment advances, mortality rates for melanoma have remained relatively stable in recent years, with an estimated 1314 melanoma deaths recorded in 2023, according to the document.

Survival rates vary considerably by stage at diagnosis, making early detection “critical”, the college states.

“However, there is no formal population-based melanoma screening in Australia due to insufficient evidence that it reduces mortality,” it adds in the position statement.

“There has been increasing interest in melanoma screening, which has been largely driven by rising health system costs for adjuvant therapies, advancements in diagnostic technologies and artificial intelligence (Al), the availability of validated risk stratification tools and consumer-driven digital technologies.”

In addition, existing peer-reviewed literature highlights the benefits of screening for melanoma in Australia, although this has mostly consisted of observational studies, the college notes.

In particular, a 2015 systematic review found that clinical whole body skin examination led to detection of melanoma tumours at an earlier stage and improved survival, suggesting that screening “may be cost-effective if targeted towards high-risk populations”, it says

“While cost-benefit analysis of this to Australia’s health system would need to be conducted, opportunistically screening individuals at high-risk of skin cancer by a health professional may be beneficial,” the statement says.

Key messages include:

  • The ACD does not recommend population-based screening for melanoma because of insufficient evidence demonstrating that it reduces mortality.
  • ACD suggests that further investment in cost-benefit analysis to Australia’s health system is needed to assess whether opportunistically screening individuals at high-risk of skin cancer by a health professional may be beneficial.
  • ACD recommends ongoing government investment in research and programs to improve and standardise risk stratification, early detection and diagnosis of skin cancer, including optimal use of new diagnostic technologies, and to inform an evidence-based, equitable targeted screening program for melanoma.
  • ACD encourages individuals to regularly conduct skin self-examinations and become familiar with their skin. Individuals should consult their health professional if they notice any changes to their skin.

“Dermatologists play a critical role in the prevention, early detection, diagnosis, optimal treatment and care of melanoma and other types of skin cancer, such as basal cell carcinoma and squamous cell carcinoma,” said ACD president Dr Adriene Lee.

“Every day we see the impact that skin cancer has on the lives of our patients. We are keenly focused on opportunities to improve early detection of skin cancer to reduce that impact.”

A full copy of the statement is published on the ACD website (link here).

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