黑色素瘤作为一种依赖检测的癌症：在一项全国性前瞻性研究中，与皮肤癌检测程序3年发病率相关的筛查和监测替代指标。

Pandeya Nirmala, Olsen Catherine M, Neale Rachel E, Whiteman David C

Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.

Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.

Br J Dermatol. 2025 Jan 24;192(2):238-246. doi: 10.1093/bjd/ljae372.

BACKGROUND

Increased levels of skin detection activities are suspected of driving recent rapid increases in melanoma incidence. While ecological studies report rising rates of skin biopsies in many industrialized populations, few studies have accessed individual-level clinical data to test the hypothesis that people exposed to skin screening and surveillance go on to experience higher levels of biopsies and excisions, and a higher incidence of melanoma.

OBJECTIVES

To measure the incidence rates of detection events and melanoma diagnoses in a national cohort during follow-up, stratified according to screening or surveillance activities in the index year.

METHODS

We conducted a prospective cohort study of 10 674 200 adults using linked data from Australia's universal health insurance scheme (2011-2016). Participants who underwent biopsies or who were diagnosed with skin cancer in 2011-12 were excluded. We then defined participants as surveilled, screened or unscreened for skin cancer based on medical claims occurring in 2013. We compared rates of biopsies, excisions for suspected melanoma and excisions for histologically confirmed melanoma during follow-up (2014-2016).

RESULTS

After adjusting for sociodemographic factors, screened people were significantly more likely than unscreened people to undergo skin biopsies [rate ratio (RR) 2.59, 95% confidence interval (CI) 2.56-2.63], excisions for suspected melanoma (RR 2.57, 95% CI 2.53-2.60) and excisions for confirmed melanoma (hazard ratio 3.32, 95% CI 3.24-3.40) during follow-up. Similarly elevated rates of subsequent diagnostic events were observed for the surveilled group. Importantly, rates of detection and rates of melanoma remained elevated in each of the subsequent years of follow-up among those who were screened or surveilled in the index year.

CONCLUSIONS

People undergoing skin screening or surveillance subsequently experience higher rates of diagnostic scrutiny and higher rates of melanoma.

背景

皮肤检测活动水平的提高被怀疑是近期黑色素瘤发病率迅速上升的原因。虽然生态学研究报告了许多工业化人群中皮肤活检率的上升，但很少有研究获取个体层面的临床数据来检验以下假设：接受皮肤筛查和监测的人随后会经历更高水平的活检和切除，以及更高的黑色素瘤发病率。

目的

在随访期间测量全国队列中检测事件和黑色素瘤诊断的发病率，并根据索引年份的筛查或监测活动进行分层。

方法

我们利用澳大利亚全民健康保险计划（2011 - 2016年）的关联数据，对10674200名成年人进行了一项前瞻性队列研究。排除了在2011 - 12年接受活检或被诊断为皮肤癌的参与者。然后，我们根据2013年发生的医疗索赔将参与者定义为接受过皮肤癌监测、筛查或未筛查。我们比较了随访期间（2014 - 2016年）活检、疑似黑色素瘤切除和组织学确诊黑色素瘤切除的发生率。

结果

在调整了社会人口学因素后，接受筛查的人在随访期间进行皮肤活检的可能性显著高于未接受筛查的人[率比（RR）2.59，95%置信区间（CI）2.56 - 2.63]、疑似黑色素瘤切除（RR 2.57，95% CI 2.53 - 2.60）和确诊黑色素瘤切除（风险比3.32，95% CI 3.24 - 3.40）。在监测组中也观察到了类似的后续诊断事件发生率升高。重要的是，在索引年份接受筛查或监测的人群中，随访的后续各年中检测率和黑色素瘤发病率仍然较高。