newsGP – Routine skin checks detecting a high proportion of “non-harmful” melanomas


But does this mean that general practitioners should change their clinical practice?

New research indicates that up to 29% of melanomas detected during skin checks may “never have come to light” if that person had not been screened.

Almost a third of melanomas detected during routine skin checks may not be harmful, according to new research from QIMR Berghofer.

The observational studywhich followed almost 44,000 Queenslanders aged 40 to 69 with no history of melanoma for seven years, found that detections were significantly higher in those who had their skin examined regularly by a doctor before enrolling in the study.

He concluded that people who undergo 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 results indicate that up to 29% of melanomas detected during skin checks may ‘never have come to light’ if that person had not been screened.

“This suggests that skin exams and biopsies pick up things that look like melanomas, but they don’t always behave like them or cause damage,” he said.

“Melanoma can be a very dangerous cancer and our study in no way diminishes the importance of good prevention, screening and treatment.

“But it opens up exciting research possibilities to improve the diagnosis and treatment of the disease.”

According to the authors of the paper, the findings offer the first estimate of the potential overdiagnosis of melanoma using individual patient data and underscore the need for further research to determine why some melanomas appear to remain dormant and undetected for long periods of time. periods.

But if almost a third of the melanomas detected may not have turned out to be harmful, what does this mean for general practitioners who are regularly the first port of call for people wishing to have their skin checked?

For Dr Jeremy Hudson, Chair of RACGP Special Interest Dermatology, the message is “keep calm and carry on”.

“Overdiagnosis is a broad term that is difficult to define,” he said. newsGP.

“In this context, this means that 29% of melanomas in situ were ‘overdetected’ because theoretically they were never going to cause harm. But practically, we cannot say which 29% of melanomas are “not harmful”.

“We don’t know why some melanomas behave this way, for example, if it’s immune or genetic factors… [so] this study makes no difference to skin controls or screening at this time.

One of the outcomes the researchers hope will come 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 precise tools would benefit patients, doctors and the healthcare system.

“Patients diagnosed with melanoma have to live with the fact that they have life-threatening cancer and undergo continual examinations and examinations. It is a life-changing event,” he said.

“Fortunately, most people diagnosed with melanoma in Australia can expect an excellent prognosis, as doctors there are world leaders in detecting and treating this disease.

“If we can find a way to distinguish melanomas with a good prognosis from very unpleasant melanomas, we might be able to offer patients better information about their condition and more appropriate treatment options.

“It would also help ease the strain on the healthcare system, because treating melanoma is very, very expensive.”

QIMR Berghofer’s QSkin study team will continue their research by investigating whether there are particular genes that influence melanoma behavior and the development of more severe disease.

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