The melanoma mortality rate in the United States increased by 1.7% annually between 1973 and 1990, then decreased or stabilized thereafter.[1] The changes in this trend in the 1990s might be due to prevention and/or early detection practices.

More than 90% of melanomas that arise in the skin can be recognized with the naked eye. Very often, there is a prolonged horizontal growth phase during which time the tumor expands centrifugally beneath the epidermis but does not invade the underlying dermis. This horizontal growth phase may provide lead time for early detection. Melanoma is more easily cured if treated before the onset of the vertical growth phase with its metastatic potential.[2]

The probability of tumor recurrence within 10 years after curative resection is less than 10% with tumors less than 1.4 mm in thickness. For patients with tumors less than 0.76 mm in thickness, the likelihood of recurrence is less than 1% in 10 years.[3]

Various observational studies exploring the possibility that melanoma screening may be effective have been reported. An educational campaign in western Scotland, promoting awareness of the signs of suspicious skin lesions and encouraging early self-referral, showed a decrease in mortality rates associated with the campaign.[4] No randomized controlled trials have been performed, however, to assess screening efficacy, though one randomized study is under way in Australia.[5] A case-control study of 650 cases (and 549 controls) diagnosed in Connecticut showed that skin self-examination was associated with reduced melanoma incidence. The authors estimated that monthly skin self-examination might decrease disease-specific mortality by 63%,[6] but the observed incidence effects may have been the result of study biases, which frequently affect case-control study designs.[7]

Differentiating between benign and malignant melanocytic tumors during histologic examination of biopsy specimens has been shown to be unreliable even in the hands of experienced dermatopathologists.[8] This fact undermines results of studies examining screening effectiveness and also may undermine the effectiveness of any screening intervention. Furthermore, this suggests that requesting a second opinion regarding the pathology of biopsy specimens may be important.[8]

References

1. Ries LAG, Eisner MP, Kosary CL, et al., eds.: SEER Cancer Statistics Review, 1975-2002. Bethesda, Md: National Cancer Institute, 2005. Also available online. Last accessed May 30, 2008. 
   
   
2. Friedman RJ, Rigel DS, Kopf AW: Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin 35 (3): 130-51, 1985 May-Jun.  [PUBMED Abstract]
   
   
3. Blois MS, Sagebiel RW, Abarbanel RM, et al.: Malignant melanoma of the skin. I. The association of tumor depth and type, and patient sex, age, and site with survival. Cancer 52 (7): 1330-41, 1983.  [PUBMED Abstract]
   
   
4. MacKie RM, Hole D: Audit of public education campaign to encourage earlier detection of malignant melanoma. BMJ 304 (6833): 1012-5, 1992.  [PUBMED Abstract]
   
   
5. Aitken JF, Elwood JM, Lowe JB, et al.: A randomised trial of population screening for melanoma. J Med Screen 9 (1): 33-7, 2002.  [PUBMED Abstract]
   
   
6. Berwick M, Begg CB, Fine JA, et al.: Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst 88 (1): 17-23, 1996.  [PUBMED Abstract]
   
   
7. Elwood JM: Skin self-examination and melanoma. J Natl Cancer Inst 88 (1): 3-5, 1996.  [PUBMED Abstract]
   
   
8. Farmer ER, Gonin R, Hanna MP: Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists. Hum Pathol 27 (6): 528-31, 1996.  [PUBMED Abstract]
   
   

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