01 Aug Do Dermatologists Find Thinner Melanomas?
MedicalResearch.com Interview with:
Estee L. Williams, MD
SUNY Downstate Medical Center, Brooklyn, New York
Madfes Integrated Dermatology, New York, New York
Medical Research: What are the main findings of the study?
Dr. Williams: In our retrospective review of all melanomas diagnosed at the Veterans’ Affairs Hospital in Brooklyn since 2000, we discovered that although a majority of the melanomas (63%) were found by the dermatologist during a yearly “full body” screening examination (versus detection by the patient), melanomas found by the dermatologist were not necessarily thinner (hence, earlier, more curable) than those found by the patient.
Medical Research: Were any of the findings unexpected?
Dr. Williams: Yes. We had assumed that dermatologist-detection would be superior to patient-detection in terms of finding melanomas sooner, given the physician’s expert eye and thorough exam. But, to our surprise, this was not the case, as there was no statistically significant difference in the mean thickness between the detection groups. Obviously these findings need to be interpreted in the proper context.
Medical Research: What should clinicians and patients take away from your report?
Dr. Williams: Skin cancer is starting to get the attention it deserves. On Tuesday July 28 2014, , U.S. Surgeon General Dr. Boris Lushniak issued a statement declaring skin cancer a “major health problem.” Those of us who practice dermatology are well aware that full body skin cancer screening is not formally recommended by the United States Preventive Services Task Force due to lack of rigorous studies demonstrating a clear survival benefit. In reality, many doctors do not offer their patients the yearly full skin check, even though this is a relatively low-risk intervention. Melanoma is a preventable disease, but deadly when not detected early enough. The question of skin cancer screening is enormously important, but without large prospective studies looking at the issue in the American population, the jury is still out.
The take-away is that curbing melanoma mortality will require a multi-faceted approach, including screening, patient and public education, and sun-safe practices. But, it should not stop there. We need to stay abreast of the myriad newly emerging technological developments designed to facilitate melanoma detection, be it in the form of in-office devices such as dermoscopy, apps for patient self-use, and other imaging-based diagnostic tools. This is an exciting time.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Williams: We need a large prospective study on skin cancer screening in the American population, as was done in Germany with the SCREEN Project.
Relationship Between Melanoma Detection Pattern and Tumor Thickness
Williams, Estee L. et al. American Journal of Preventive Medicine