Shellenberger Richard, Nabhan Mohammed, Kakaraparthi Sweta
a Internal Medicine Department, St. Joseph Mercy Hospital , Ann Arbor, MI, USA.
Ann Med. 2016;48(3):142-8. doi: 10.3109/07853890.2016.1145795. Epub 2016 Feb 25.
Malignant melanoma ranks fifth in the number of new cases annually in the United States (US). Despite increasing incidence and lack of recent improvement in mortality, national melanoma screening guidelines are currently not in existence. Our purpose was to review the evidence regarding screening whole-body skin examinations for early detection and a possible mortality benefit for malignant melanoma. Data sources for our review were MEDLINE Complete, PubMed, Cochrane Library, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. Study selection included: epidemiologic data from the US and European cancer surveillance registries, population-based case-control screening trials, computer-simulated Markov model trials, and survey trials. Studies were limited to those published in the English language. Data was extracted using a dual extraction method. Data from studies have shown that the mortality of malignant melanoma is highly predicated on the tumor thickness at the time of diagnosis. Our data review is in support of the implementation of whole-body skin examinations, performed by primary care physicians, for the purpose of early detection of melanoma. A large national population-based, case-control, skin cancer screening trial in Germany has shown a reduction in melanoma-specific mortality. In conclusion, our review of the evidence supports physicians performed whole-body skin examination can lead to the detection of earlier stage melanomas as well as to a reduction in disease-specific mortality. We found a paucity of randomized trials to be a limitation of screening studies for many cancers, including melanoma. To improve screening rates and early detection of malignant melanoma, we propose making skin cancer education part of the curriculum in US primary care residency programs to become the genesis for widespread melanoma screening. Our study had no funding.
恶性黑色素瘤在美国每年新增病例数中排名第五。尽管发病率不断上升且近期死亡率缺乏改善，但目前尚无全国性的黑色素瘤筛查指南。我们的目的是回顾有关进行全身皮肤检查以早期发现恶性黑色素瘤并可能降低死亡率的证据。我们回顾的数据来源包括MEDLINE Complete、PubMed、Cochrane图书馆、Cochrane系统评价数据库和ClinicalTrials.gov。研究选择包括：来自美国和欧洲癌症监测登记处的流行病学数据、基于人群的病例对照筛查试验、计算机模拟的马尔可夫模型试验和调查试验。研究限于以英文发表的研究。数据采用双重提取方法提取。研究数据表明，恶性黑色素瘤的死亡率高度取决于诊断时肿瘤的厚度。我们的数据回顾支持由初级保健医生进行全身皮肤检查以早期发现黑色素瘤。德国一项基于全国大规模人群的病例对照皮肤癌筛查试验显示黑色素瘤特异性死亡率有所降低。总之，我们对证据的回顾支持医生进行的全身皮肤检查可导致早期黑色素瘤的发现并降低疾病特异性死亡率。我们发现缺乏随机试验是包括黑色素瘤在内的许多癌症筛查研究的一个局限。为了提高筛查率和早期发现恶性黑色素瘤，我们建议将皮肤癌教育纳入美国初级保健住院医师培训项目的课程，以成为广泛开展黑色素瘤筛查的开端。我们的研究没有资金支持。
