The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.
Surveillance, Epidemiology and Research Program, Kirby Institute, University of New South Wales, Sydney, Australia.
JAMA Dermatol. 2021 Dec 1;157(12):1425-1436. doi: 10.1001/jamadermatol.2021.3884.
Early melanoma diagnosis is associated with better health outcomes, but there is insufficient evidence that screening, such as having routine skin checks, reduces mortality.
To assess melanoma-specific and all-cause mortality associated with melanomas detected through routine skin checks, incidentally or patient detected. A secondary aim was to examine patient, sociodemographic, and clinicopathologic factors associated with different modes of melanoma detection.
DESIGN, SETTING, AND PARTICIPANTS: This prospective, population-based, cohort study included patients in New South Wales, Australia, who were diagnosed with melanoma over 1 year from October 23, 2006, to October 22, 2007, in the Melanoma Patterns of Care Study and followed up until 2018 (mean [SD] length of follow-up, 11.9 [0.3] years) by using linked mortality and cancer registry data. All patients who had invasive melanomas recorded at the cancer registry were eligible for the study, but the number of in situ melanomas was capped. The treating doctors recorded details of melanoma detection and patient and clinical characteristics in a baseline questionnaire. Histopathologic variables were obtained from pathology reports. Of 3932 recorded melanomas, data were available and analyzed for 2452 (62%; 1 per patient) with primary in situ (n = 291) or invasive (n = 2161) cutaneous melanoma. Data were analyzed from March 2020 to January 2021.
Melanoma-specific mortality and all-cause mortality.
A total of 2452 patients were included in the analyses. The median age at diagnosis was 65 years (range, 16-98 years), and 1502 patients (61%) were men. A total of 858 patients (35%) had their melanoma detected during a routine skin check, 1148 (47%) self-detected their melanoma, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion, and 153 (6%) reported "other" presentation. Routine skin-check detection of invasive melanomas was associated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60; P < .001) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76; P < .001), adjusted for age and sex, compared with patient-detected melanomas. After adjusting for prognostic factors including ulceration and mitotic rate, the associations were 0.68 (95% CI, 0.44-1.03; P = .13), and 0.75 (95% CI, 0.63-0.90; P = .006), respectively. Factors associated with higher odds of routine skin-check melanoma detection included being male (female vs male, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), having previous melanoma (vs none, OR, 2.36; 95% CI, 1.77-3.15; P < .001), having many moles (vs not, OR, 1.39; 95% CI, 1.10-1.77; P = .02), being 50 years or older (eg, 50-59 years vs <40 years, OR, 2.89; 95% CI, 1.92-4.34; P < .001), and living in nonremote areas (eg, remote or very remote vs major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003).
In this cohort study, melanomas diagnosed through routine skin checks were associated with significantly lower all-cause mortality, but not melanoma-specific mortality, after adjustment for patient, sociodemographic, and clinicopathologic factors.
早期黑色素瘤的诊断与更好的健康结果相关，但没有足够的证据表明筛查（如常规皮肤检查）可以降低死亡率。
评估通过常规皮肤检查、偶然或患者发现的黑色素瘤检测与黑色素瘤特异性和全因死亡率的关系。次要目的是研究与不同黑色素瘤检测方式相关的患者、社会人口学和临床病理因素。
设计、地点和参与者：这是一项前瞻性、基于人群的队列研究，纳入了 2006 年 10 月 23 日至 2007 年 10 月 22 日期间在新南威尔士州澳大利亚被诊断为黑色素瘤的患者，在 Melanoma Patterns of Care Study 中进行了为期 1 年以上的随访，并通过链接的死亡率和癌症登记数据进行了随访，直到 2018 年（平均[标准差]随访时间为 11.9[0.3]年）。所有在癌症登记处记录有侵袭性黑色素瘤的患者都有资格参加这项研究，但原位黑色素瘤的数量是有限的。治疗医生在基线问卷中记录了黑色素瘤检测和患者及临床特征的详细信息。组织病理学变量从病理报告中获得。在 3932 例记录的黑色素瘤中，对 2452 例（62%；每位患者 1 例）原发性原位（n=291）或侵袭性（n=2161）皮肤黑色素瘤的数据进行了分析。数据分析于 2020 年 3 月至 2021 年 1 月进行。
黑色素瘤特异性死亡率和全因死亡率。
共纳入 2452 例患者进行分析。诊断时的中位年龄为 65 岁（范围为 16-98 岁），1502 例（61%）患者为男性。858 例（35%）患者的黑色素瘤是在常规皮肤检查中发现的，1148 例（47%）是患者自行发现的，293 例（12%）是在检查另一个皮肤病变时偶然发现的，153 例（6%）报告了“其他”表现。常规皮肤检查发现侵袭性黑色素瘤与黑色素瘤特异性死亡率降低 59%（亚危险比，0.41；95%CI，0.28-0.60；P<0.001）和全因死亡率降低 36%（风险比，0.64；95%CI，0.54-0.76；P<0.001）相关，这与患者发现的黑色素瘤相比，调整了年龄和性别因素。在调整了包括溃疡和有丝分裂率在内的预后因素后，关联分别为 0.68（95%CI，0.44-1.03；P=0.13）和 0.75（95%CI，0.63-0.90；P=0.006）。与常规皮肤检查黑色素瘤检出率较高相关的因素包括男性（女性比男性，优势比[OR]，0.73；95%CI，0.60-0.89；P=0.003）、有既往黑色素瘤（无 vs 无，OR，2.36；95%CI，1.77-3.15；P<0.001）、有多个痣（无 vs 无，OR，1.39；95%CI，1.10-1.77；P=0.02）、50 岁或以上（如，50-59 岁 vs <40 岁，OR，2.89；95%CI，1.92-4.34；P<0.001）和居住在非偏远地区（如，偏远或非常偏远地区 vs 主要城市，OR，0.23；95%CI，0.05-1.04；P=0.003）。
在这项队列研究中，通过常规皮肤检查诊断的黑色素瘤与全因死亡率显著降低相关，但与黑色素瘤特异性死亡率无关，这是在调整了患者、社会人口学和临床病理因素之后得出的结果。
