Targeted screening for melanoma after a 5-year follow-up: Comparison of melanoma incidence and lesion thickness at diagnosis in screened (versus unscreened) patients

Abstract

Melanoma incidence and mortality rates are increasing worldwide. While screening appears to be inefficient, targeted screening might be effective. Objective: To assess the relative risk of developing a melanoma in a population that participated in targeted screening program compared with the general population. The secondary objective was to identify the factors related to melanoma thickness at the time of diagnosis. Design, setting, and participants: We assessed the incidence of melanoma from 2011 to 2015 in a cohort of 3832 patients at elevated risk of melanoma living on the west coast of France. The patients were older than 20 years, selected using the Self-Assessment of Melanoma risk score, and invited each spring to undergo a complete skin examination as part of a pilot targeted screening program for melanoma. Main outcome, measures: We calculated the relative risk of developing a melanoma, based on the comparison of melanoma incidence in patients who participated in the targeted screening and in the general population in the geographic area. Data collection was performed by the regional cancer registry, in accordance with international standards. Demographical variables and histological variables related to the identification of a thick melanoma (stage 2 and higher) were also analyzed. Results: 3 169 patients developed melanomas between April 2011 and December 2015. The relative risk of developing a melanoma during the five years of follow-up was 4.33 [4.17;4.50] in patients who participated in the pilot targeted screening program compared with the general population. The following factors were associated with the identification of thick melanomas: male gender (OR = 1.40; 95% CI [1.18−1.66]), age older than 75 years (OR = 1.72; 95% CI [1.38−2.14]), and residence in a rural area (OR = 1.48; 95% CI [1.21−1.80]). The targeted screening program did not lead to a lower proportion of thick melanomas at the time of diagnosis (OR=0.48 [0.11−1.40]). Conclusions and relevance: Targeted screening for melanoma allows general practitioners to focus their attention, energy, and time on at-risk populations with greater efficiency. However, participation in the pilot screening program was not associated with the identification of thinner melanomas at the time of diagnosis. Trial registration: This trial was registered in the Clinical Trials database before study enrollment commenced (ClinicalTrials.gov; Registration number: NCT01610531)