Screening and Prevention Measures for Melanoma: Is There a Survival Advantage?
Melanoma (K Margolin, Section Editor)
First Online: 21 August 2012 DOI:
10.1007/s11912-012-0256-6 Cite this article as: Curiel-Lewandrowski, C., Chen, S.C., Swetter, S.M. et al. Curr Oncol Rep (2012) 14: 458. doi:10.1007/s11912-012-0256-6 Abstract
Controversy has emerged over the past decades regarding the value and impact of melanoma screening to detect early stage disease for improved prognosis. Those questioning the benefits of prevention efforts base their arguments on the absence of prospective, randomized studies demonstrating decreased melanoma mortality to justify the cost associated with screening and educational campaigns. For those in favor of melanoma screening, the lack of proven survival benefit is not a justification to abandon this approach, but rather a reflection of the lack of resources necessary to conduct a long-term trial. In 2009, the US Preventive Services Task Force (USPSTF)report did not recommend routine primary care screening for the general population given the absence of evidence. However, since the USPSTF report, a series of new studies are available, which support the potential benefit of screening and have the potential to significantly impact current policies regarding skin cancer screening, particularly for melanoma.
Keywords Cutaneous melanoma Surveillance Survival Prevention Early detection References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Purdue MP, Freeman LE, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. J Invest Dermatol. 2008;128:2905–8.
Reed KB, Brewer JD, Lohse CM, et al. Increasing incidence of melanoma among young adults: an epidemiological study in Olmsted County, Minnesota. Mayo Clinic Proc. 2012;87:328–34.
Zhang M, Qureshi AA, Geller AC, et al. Use of tanning beds and incidence of skin cancer. J Clin Oncol. 2012;30:1588–93.
Weir HK, Marrett LD, Cokkinides V, et al. Melanoma in adolescents and young adults (ages 15–39 years): United States, 1999–2006. J Am Acad Dermatol. 2011;65(5 Suppl 1):S38–49.
• Bradford PT, Anderson WF, Purdue MP, et al. Rising melanoma incidence rates of the trunk among younger women in the United States. Cancer Epidemiology, Biomarkers & Prevention. 2010;19:2401–6.
Case and population data obtained from SEER (1975
2006) show that melanomas are rising preferentially on the trunk among young women
• Erdmann F, Lortet-Tieulent J, Schüz J, et al. International trends in the incidence of malignant melanoma 1953–2008-are recent generations at higher or lower risk? Int J Cancer. 2012. doi:
Analysis of melanoma incidence data from 39 population-based cancer registries and potential beneficial implication of prevention strategies.
World Health Organization, International Agency for Research on Cancer. GLOBOCAN 2008. Cancer incidence and mortality worldwide in 2008. Available at:
. Accessed May 12, 2012; 2011.
Schneider JS, Moore II DH, Mendelsohn ML. Screening program reduced melanoma mortality at the Lawrence Livermore National Laboratory, 1984 to 1996. J Am Acad Dermatol. 2008;58:741–9.
Gandini S, Sera F, Cattaruzza MS. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer. 2005;41:2040–59.
Geller AC, Elwood M, Swetter SM. Factors related to the presentation of thin and thick nodular melanoma from a population-based cancer registry in Queensland Australia. Cancer. 2009;115:1318–27.
Swetter SM, Johnson TM, Miller DR. Melanoma in middle-aged and older men: a multi-institutional survey study of factors related to tumor thickness. Arch Dermatol. 2009;145:397–404.
Kasparian NA, McLoone JK, Meiser B. Skin cancer-related prevention and screening behaviors: a review of the literature. J Behav Med. 2009;32:406–28. Epub 2009;Jun 12.
Banks BA, Silverman RA, Schwartz RH, Tunnessen WW. Attitudes of teenagers towards sun exposure and sunscreen use. Pediatrics. 1992;89:40–2.
Mermelstein RJ, Riesenberg LA. Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychol. 1992;11:371–6.
Geller AC, Colditz G, Oliveria S, et al. Use of sunscreen, sunburning rates, and tanning bed use among more than 10,000 US children and adolescents. Pediatrics. 2002;109:1009–14.
Wichstrøm L. Predictors of Norwegian adolescents' sunbathing and use of suncreen. Health Psychol. 1994;13:412–20.
Campbell HS, Birdsell JM. Knowledge, beliefs, and sun protection behaviors of Alberta Adults. Prev Med. 1994;23:160–6.
Bränström R, Kasparian NA, Chang YM, et al. Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomarkers Prev. 2010;19:2199–210.
Linos E, Keiser E, Kanzler M, et al. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003–2006. Cancer Causes Control. 2012;23:133–40.
Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.
Berwick M, Begg CB, Fine JA, Roush GC, Barnhill RL. Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst. 1996;88:17–23.
Carli P, De Giorgi V, Palli D, et al. Italian Multidisciplinary Group on Melanoma. Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma. Arch Dermatol. 2003;139:607–12.
Pollitt RA, Geller AC, Brooks DR, et al. Efficacy of skin self-examination practices for early melanoma detection. Cancer Epidemiol Biomarkers Prev. 2009;18:3018–23.
Aneja S, Aneja S, Bordeaux JS. Association of increased dermatologist density with lower melanoma mortality. Arch Dermatol. 2012;148:174–8.
Aitken JF, Janda M, Lowe JB, et al. Prevalence of whole-body skin self-examination in a population at high risk for skin cancer (Australia). Cancer Causes and Control. 2004;15:453–63.
Douglass HM, McGee R, Williams S. Are young adults checking their skin for melanoma? Australian and New Zealand Journal of Public Health. 1998;22:562–7.
Friedman L, Bruce S, Webb J, Weinberg A, Cooper H. Skin self-examination in a population at increased risk for skin cancer. Am J Prev Med. 1993;359–64.
Girgis A, Campbell E, Redman S, Sanson-Fisher R. Screening for melanoma: a community survey of prevalence and predictors. Med J Aust. 1991;154:338–43.
Robinson J, Rigel D, Amonette R. What promotes skin self-examination? J Am Acad Dermatol. 1998;39:752–7.
Weinstock M, Martin R, Risica P, et al. Thorough skin examination for the early detection of melanoma. Am J Prev Med. 1999;17:169–75.
Robinson J, Fisher S, Turrisi R. Predictors of skin self-examination performance. Cancer. 2002;95:135–46.
Aitken JF, Youl PH, Janda M, et al. Increase in skin cancer screening during a community-based randomized intervention trial. Int J Cancer. 2006;118:1010–6.
Janda M, Youl PH, Lowe JB, et al. Attitudes and intentions in relation to skin checks for early signs of skin cancer. Prev Med. 2004;39:11–8.
LeBlanc WG, Vidal L, Kirsner R, et al. Reported skin cancer screening of US adult workers. J Am Acad Dermatol. 2008;59:55–63.
Rodriguez GL, Ma F, Federman DG, et al. Predictors of skin cancer screening practice and attitudes in primary care. J Am Acad Dermatol. 2007;57:775–81.
Saraiya M, Hall HI, Thompson T, Hartman A, et al. Skin cancer screening among U.S. adults from, 1992, 1998, and 2000 National Health Interview Surveys. Prev Med. 2004;39:308–14.
Skin cancer protection and early detection. American Cancer Society Web site. Available at:
. Accessed May 2012.
Oliveria SA, Dusza SW, Phelan DL, et al. Patient adherence to skin self-examination. effect of nurse intervention with photographs. Am J Prev Med. 2004;26:152–5.
Robinson JK, Turrisi R, Stapleton J. Efficacy of a partner assistance intervention designed to increase skin self-examination performance. Arch Dermatol. 2007;143:37–41.
Robinson JK, Turrisi R, Mallett K, Stapleton J, Pion M. Comparing the efficacy of an in-person intervention with a skin self-examination workbook. Arch Dermatol. 2010;146:91–4.
Janda M, Neale RE, Youl P, et al. Impact of a video-based intervention to improve the prevalence of skin self-examination in men 50 years or older: the randomized skin awareness trial. Arch Dermatol. 2011;147:799–806.
• Goulart JM, Quigley EA, Dusza S, et al. Skin cancer education for primary care physicians: a systematic review of published evaluated interventions. INFORMED (INternet curriculum FOR Melanoma Early Detection) Group. J Gen Intern Med. 2011;26:1027–35. Epub 2011 Apr 7.
Comprehensive review of skin cancer educational programs targeting primary care providers.
Moore MM, Geller AC, Zhang Z, et al. Skin cancer examination teaching in US medical education. Arch Dermatol. 2006;142:439–44.
Geller AC, Venna S, Prout M, et al. Should the skin cancer examination be taught in medical school? Arch Dermatol. 2002;138:1201–3.
Buster KJ, Stevens EI, Elmets CA. Dermatologic health disparities. Dermatol Clin. 2012;30:53–9. viii.
Oliveria SA, Heneghan MK, Cushman LF, Ughetta EA, Halpern AC. Skin cancer screening by dermatologists, family practitioners, and internists: barriers and facilitating factors. Arch Dermatol. 2011;147:39–44.
Shaikh WR, Geller A, Alexander G, et al. Developing an interactive web-based learning program on skin cancer: the learning experiences of clinical educators. J Cancer Educ. 2012.
Vogel VG. Chemoprevention strategies 2006. Curr Treat Options Oncol. 2007;8:74–88.
Singh T, Katiyar SK. Green tea catechins reduce invasive potential of human melanoma cells by targeting COX-2, PGE2 receptors and epithelial-to-mesenchymal transition. PLoS One. 2011;6:e25224.
Szekeres T, Saiko P, Fritzer-Szekeres M, Djavan B, Jäger W. Chemopreventive effects of resveratrol and resveratrol derivatives. Ann N Y Acad Sci. 2011;1215:89–95.
Chakraborty G, Kumar S, Mishra R, Patil TV, Kundu GC. Semaphorin 3A suppresses tumor growth and metastasis in mice melanoma model. PLoS One. 2012;7:e33633.
Szyszka P, Zmijewski MA, Slominski AT. New vitamin D analogs as potential therapeutics in melanoma. Expert Rev Anticancer Ther. 2012;12:585–99.
Joosse A, Koomen ER, Herings R, Guchelaar HJ, Nijsten T. Non steroidal anti-inflammatory drugs and melanoma risk: large Dutch population based case-control study. J Invest Dermatol. 2009;129:2620–7.
• Curiel-Lewandrowski C, Nijsten T, Gomez ML, et al. Long-term use of nonsteroidal anti-inflammatory drugs decreases the risk of cutaneous melanoma: results of a United States case-control study. J Invest Dermatol. 2011;131:1460–8.
A US case control study suggesting a protective effect of NSAIDs in melanoma.
• Johannesdottir SA, Chang ET, Mehnert F, et al. Nonsteroidal anti-inflammatory drugs and the risk of skin cancer: A population-based case-control study. Cancer. 2012. doi:
European case control study suggesting a protective effect of NSAIDs in melanoma.
• Curiel-Lewandrowski C, Swetter SM, Einspahr JG, et al. Randomized, double-blind, placebo-controlled trial of sulindac in individuals at risk for melanoma: evaluation of potential chemopreventive activity. Cancer. 2012. doi:
First study demonstrating the systemic delivery and distribution of a potential chemopreventive agent to melanocytic nevi.
Coory M, Baade P, Aitken J, et al. Trends for in situ and invasive melanoma in Queensland, Australia, 1982–2002. Cancer Causes & Control. 2006;17:21–7.
Baade P, Meng X, Youlden D, et al. Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990–2006. Int J Cancer. 2012;130:170–8.
•• Swetter SM, Pollitt RA, Johnson TM, Brooks DR, Geller AC. Behavioral determinants of successful early melanoma detection role of self and physician skin examination. Cancer. 2011. doi:
Survey based study demonstrating that self-skin examination and physician skin exam were complementary early detection strategies, particularly in men aged >60 years, in whom both partial and full-body physician examination were associated with thinner tumors. The study overall support the role of physician based examination as a venue to detect early melanomas.
Preventive US. Services Task Force. Counseling to prevent skin cancer: recommendations and rationale. Am Fam Physician. 2004;69:903–4.
Halpern A. Melanoma early detection. Hematol Oncol Clin North Am. 2009;23:481–500.
• Aitken JF, Elwood M, Baade PD, Youl P, English D. Clinical whole-body skin examination reduces the incidence of thick melanomas. Int J Cancer. 2010;126:450–8.
Analysis performed as part of the population-based case-control study in Queensland demonstrating that screening was associated with a 38 % higher risk of being diagnosed with a thin invasive melanoma.
Aitken JF, Elwood JM, Lowe JB, et al. A randomized trial of population screening for melanoma. J Med Screen. 2002;9:33–7.
From L, Marret L, Rosen C, et al. Screening for Skin Cancer: a systematic review. A quality initiative of the program in evidence-based care (PEBC), Cancer Care Ontario (CCO). 2007.
Janda M, Lowe JB, Elwood M, et al. Do centralized skin screening clinics increase participation in melanoma screening (Australia)? Cancer Causes Control. 2006;17:161–8.
Aitken JF, Janda M, Elwood M, et al. Clinical outcomes from skin screening clinics within a community-based melanoma screening program. J Am Acad Dermatol. 2006;54:105–14.
Breitbart EW, Waldmann A, Nolte S, et al. Systematic skin cancer screening in Northern Germany. J Am Acad Dermatol. 2012;66:201–11.
•• Katalinic A, Waldmann A, Weinstock MA, et al. Does skin cancer screening save lives?: An observational study comparing trends in melanoma mortality in regions with and without screening. Cancer. 2012. doi:
Population-based skin cancer screening program in Germany demonstrating a significant decrease in melanoma mortality for both men and women.
Katalinic A, Kunze U, Schäfer T. Epidemiology of cutaneous melanoma and non-melanoma skin cancer in Schleswig-Holstein, Germany: incidence, clinical subtypes, tumour stages and localization (epidemiology of skin cancer). Br J Dermatol. 2003;149:1200–6.
• Geller AC, Greinert R, Sinclair C, et al. A nationwide population-based skin cancer screening in Germany: proceedings of the first meeting of the International Task Force on Skin Cancer Screening and Prevention (September 24 and 25, 2009. Cancer Epidemiol. 2010;34:355–8.
Good review of the prevention work leading to the current effort to carryout a nation wide screening intervention in Germany.
Swetter SM, Waddell BL, Vazquez MD, Khosravi VS. Increased effectiveness of targeted skin cancer screening in the Veterans Affairs population of Northern California. Prev Med. 2003;36:164–71.
Wang SQ, Kopf AW, Koenig K. et al. Detection of melanomas in patients followed up with total cutaneous examinations, total cutaneous photography, and dermoscopy J Am Acad Dermatol. 2004;50:15–20.
Rademaker M, Oakley A. Digital monitoring by whole body photography and sequential digital dermoscopy detects thinner melanomas. J Prim Health Care. 2010;2:268–72.
Feit NE, Dusza SW, Marghoob AA. Melanomas detected with the aid of total cutaneous photography. Br J Dermatol. 2004;150:706–14.
Banky JP, Kelly JW, English DR, et al. Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol. 2005;141:998–1006.
Federman DG, Kravetz JD, Kirsner RS. Skin cancer screening by dermatologists: prevalence and barriers. J Am Acad Dermatol. 2002;46:710–4.
Mar V, Wolfe R, Kelly JW. Predicting melanoma risk for the Australian population. Aust J Dermatol. 2011;52:109–16.
Fortes C, Mastroeni S, Bakos L, et al. Identifying individuals at high risk of melanoma: a simple tool. Eur J Cancer Prev. 2010;19:393–400.
Cho E, Rosner BA, Feskanich D, Colditz GA. Risk factors and individual probabilities of melanoma for whites. J Clin Oncol. 2005;23:2669–75.
Freedberg KA, Geller AC, Miller DR, et al. Screening for malignant melanoma: a cost-effectiveness analysis. J Am Acad Dermatol. 1999;41:738–45.
Losina E, Walensky RP, Geller A, et al. Visual screening for malignant melanoma: a cost-effectiveness analysis. Arch Dermatol. 2007;143:21–8.
• Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102:605–13.
Comprehensive review on the phenomenon of cancer overdiagnosis. It also proves an estimation of cancer overdiagnosis based on results obtained from randomized trials
Cartee TV, Kini SP, Chen SC. S124 Melanoma reporting to central cancer registries by US dermatologists: an analysis of the persistent knowledge and practice gap. JAAD. 2011;65.
Cockburn M, Swetter SM, Peng D, et al. Melanoma under reporting: why does it happen, how big is the problem, and how do we fix it? J Am Acad Dermatol. 2008;59:1081–5.
Koh HK, Geller A, Miller DR, Clapp RW, Lew RA. Underreporting of cutaneous melanoma in cancer registries nationwide. J Am Acad Dermatol. 1992;27:1035–6.
Criscione VD, Weinstock MA. Melanoma thickness trends in the United States, 1988–2006. J Investig Dermatol. 2010;130:793–7.
PubMed CrossRef Copyright information
© Springer Science+Business Media, LLC 2012