Serial screening for melanoma: measures and strategies that have consistently achieved early detection and cure

Abstract

Objective: To determine the effectiveness of a serial screening program in achieving early detection and preventing death in patients at increased risk for melanoma.

Design: Retrospective study.

Setting: Private dermatology practice.

Patients: The study included all patients at increased risk for melanoma who were screened in the program during the 17-year period, July 1, 1992-June 30, 2009 (=1108 patients per year).

Main outcome measures: Survival and indicators of early detection.

Results: All melanomas that developed in program participants during the 17-year period were detected early and there were no deaths, metastases, recurrences, nor need for sentinel node biopsies. An analysis of melanoma cases seen in five recent years revealed additional evidence of consistent early detection: 80 percent of the lesions were in situ, no lesions were greater than 0.15 mm in Breslow depth, and all lesions were in the radial growth phase, a stage almost always associated with cure. Four measures, often absent in mass screening programs, contributed to very early detection and cure: thorough serial examinations, biopsying suspicious lesions (particularly pigmented lesions that were highly irregular and/or approaching black in color), recalling patients every six months to detect all melanomas in the radial growth phase, and educating patients on the need to return.

Conclusion: An office-based surveillance program that includes serial full skin examinations and ongoing recalls appears capable of detecting melanoma at a very early stage when cures can be realized in almost every case. Therefore, when patients present with recognized risk factors for melanoma, dermatologists should seriously consider recommending and performing such serial screening procedures.