Warren Alpert Medical School of Brown University, Providence, RI.
Department of Dermatology, the Warren Alpert Medical School of Brown University, Providence, RI.
R I Med J (2013). 2022 Apr 1;105(3):17-21.
Cutaneous melanoma is the fifth most diagnosed cancer in the United States and the incidence is increasing yearly. At present, population screening for melanoma is not recommended by national guidelines on account of insufficient evidence to assess the balance of benefits and harms. Indeed, there remains significant controversy over whether screening for melanoma via increasing the frequency of routine skin checks leads to tangible long-term health benefits for patients. In this paper, we highlight how skin cancer screening can impose harms such as overdiagnosis and suggest that the principle of non-maleficence should play a greater role in the formulation of screening policies. We also explore the pressing issue of the underdiagnosis of melanoma in particular populations. In so doing, this paper underscores how the ethical duties of non-maleficence and justice must be balanced in current dermatological practice.
皮肤黑色素瘤是美国第五大常见癌症，发病率逐年上升。目前，由于缺乏评估收益和危害平衡的充分证据，国家指南不建议对黑色素瘤进行人群筛查。实际上，通过增加常规皮肤检查的频率来筛查黑色素瘤是否会给患者带来切实的长期健康益处，仍存在很大争议。在本文中，我们强调了皮肤癌筛查如何会带来过度诊断等危害，并提出不伤害原则应该在筛查政策的制定中发挥更大的作用。我们还探讨了在特定人群中黑色素瘤漏诊的紧迫问题。通过这样做，本文强调了在当前皮肤科实践中，不伤害和正义的道德义务必须得到平衡。
