Researchers affiliated with North Florida Dermatology Associates have reported that more the half of all melanomas detected in their clinic were not found in patients presenting complaint and were earlier stage than those diagnosed following patients specific complaints. The details of this study appeared in the August 2009 issue of Archives of Dermatology.[1]

The three most common types of skin cancer are melanoma, basal cell carcinoma, and squamous cell carcinoma. Melanoma is less common than basal cell or squamous cell skin cancer but is much more aggressive and often fatal. Of the more than one million new diagnoses of skin cancer each year, roughly 62,000 involve melanoma. More than 8,000 people die of melanoma each year in the United States. What makes melanoma so dangerous is that it is more likely than other types of skin cancer to metastasize to other parts of the body. Melanoma can occur anywhere on the body. The first signs of melanoma may be a mole that changes in appearance, bleeds, or has more than one color or an irregular shape.

Survival rates for melanoma are dependent on the thickness of the primary lesion, making early detection very important. There have been growing efforts over the past decade to increase public awareness about the importance of early diagnosis of melanoma. Some have suggested that annual or every two- to three-year full-body skin examinations by a dermatologist should be performed to detect early melanomas and other skin cancers. However, the data to support this proposal in average-risk individuals is not available.

Most medical centers only recommend full-body screening for high-risk persons. This includes patients with a personal history of melanoma, a family history of melanoma, the presence multiple atypical moles, or the presence of numerous actinic keratoses.

Patients who have had one melanoma are at a greater risk of a second one than the average population. One study has found that patients who have had a skin melanoma in the past and have full-body skin examinations have thin melanomas, while unscreened and at-risk persons have thicker melanomas at diagnosis.[2] 

The current study evaluated 123 patients with skin melanoma diagnosed between 2005 and 2007 in a private clinic in Florida. They reported that 56.3% of melanomas were diagnosed by a dermatologist during a visit for an unrelated condition. Sixty percent of carcinoma-in-situ melanomas were detected by a dermatologist. Dermatologist-detected melanomas were significantly more likely to be thinner than those detected by the patient. These authors suggest that most melanomas detected in general practice were detected by dermatologist-initiated full-body skin examination. This led to the early detection of potentially curable melanomas.

Comment: This study suggests that full-body skin examination by a dermatologist can detect earlier melanomas than patient observation. However, it’s unlikely that all persons in the United States can avail themselves of such an approach due to expense; some insurance companies, however, cover such examinations.

It should be noted that the U.S. Preventive Task Force concluded that “the current evidence is insufficient to assess the balance of benefits and harms of screening for skin cancer by primary care clinicians or by patient skin self-examination.”[3] 

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