Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
Public Health Res Pract. 2022 Mar 10;32(1):3212204. doi: 10.17061/phrp3212204.
Objectives and importance of study: Melanoma and keratinocyte carcinomas impose a significant health and financial burden on the Australian population and healthcare system. The impacts of skin cancer can be minimised through early detection, as morbidity, mortality and costs of treatment are strongly associated with stage of disease at diagnosis.
Narrative review.
Building on the discussions from the Melanoma Screening Summit held in Brisbane, Australia, in 2019, we reviewed evidence related to current approaches and new opportunities for early detection of melanoma and other skin cancers.
Population-based melanoma screening is not currently recommended due to insufficient evidence that screening reduces melanoma mortality. Instead, in most countries including Australia, early detection of melanoma and keratinocyte carcinomas is undertaken opportunistically, by either the patient presenting for a routine skin check or with a lesion of concern, or by the doctor detecting a lesion incidentally. Several concerns about the current unstructured approach to skin cancer early detection have been identified, including variable quality of care, sociodemographic inequalities in medical access and health outcomes, excision of many benign lesions, overdiagnosis, gaps in workforce training, and health system inefficiencies. There has also been renewed interest in melanoma screening in Australia, driven by a changing landscape of skin cancer early detection. These changes include increasing health system costs for adjuvant therapies, advances in diagnostic technologies and artificial intelligence, the availability of validated risk-stratification tools, and consumer-driven digital technologies.
The future of skin cancer early detection in Australia and internationally may incorporate features such as a more structured approach to skin cancer risk assessment using online risk calculators and invitations to screen, consumer-driven melanoma surveillance, and new technologies for diagnosis and monitoring of lesions. High-quality research evidence is being generated across multiple research programs, and is essential to underpin any changes to policy and practice in skin cancer early detection.
黑色素瘤和角化细胞癌给澳大利亚人群和医疗保健系统带来了重大的健康和经济负担。通过早期发现可以最大程度地减少皮肤癌的影响，因为发病率、死亡率和治疗成本与诊断时疾病的阶段密切相关。
叙述性综述。
基于 2019 年在澳大利亚布里斯班举行的黑色素瘤筛查峰会的讨论，我们回顾了与黑色素瘤和其他皮肤癌早期检测的当前方法和新机会相关的证据。
由于没有足够的证据表明筛查可以降低黑色素瘤死亡率，目前不建议进行基于人群的黑色素瘤筛查。相反，在包括澳大利亚在内的大多数国家，通过患者进行常规皮肤检查或出现可疑病变，或者医生偶然发现病变，来进行黑色素瘤和角化细胞癌的早期检测。已经确定了当前非结构化皮肤癌早期检测方法存在的几个问题，包括护理质量的差异、医疗机会和健康结果的社会人口不平等、许多良性病变的切除、过度诊断、劳动力培训差距以及卫生系统效率低下。由于皮肤癌早期检测领域的变化，澳大利亚对黑色素瘤筛查的兴趣也有所恢复。这些变化包括辅助治疗的卫生系统成本增加、诊断技术和人工智能的进步、经过验证的风险分层工具的可用性以及消费者驱动的数字技术。
澳大利亚和国际上皮肤癌早期检测的未来可能包括使用在线风险计算器和筛查邀请对皮肤癌风险评估进行更结构化的方法、消费者驱动的黑色素瘤监测以及用于诊断和监测病变的新技术等特征。多个研究项目正在产生高质量的研究证据，这对于支持皮肤癌早期检测政策和实践的任何变化都是必不可少的。
