Screening for Melanoma

The media are crackling with the news that 2 new drugs show great promise for the treatment of advanced melanoma. We will review them, of course, as quickly as we can. But in the meantime, I would like to repeat something I said about a year ago in this space. Why don’t we pay more attention to screening for melanoma?

I don’t get it. We have lots of advocates for mammography, colonoscopy and, recently, lung CTs, all of which require heavy machinery, cost a lot, and expose the patient to some risks. Not to say they are not worthwhile, at least the first two. They can save lives, without a doubt. But none of them are perfect, and advanced breast cancer, colon cancer, and even lung cancer, although all horrible, are somewhat treatable.

Advanced melanoma is God’s hand on your shoulder, or at least it was until these 2 new drugs came along. Screening for melanoma requires 2 eyes and a strong light. The eyes should belong to a dermatologist, because screening yourself for melanoma, which is widely advocated, is ridiculous, in my opinion, considering where it can occur and how difficult it is to identify correctly. And most primary care providers, I would bet, cannot reliably distinguish a melanoma from the thousand other ills that skin is heir to, especially in older patients.

Early melanoma is nearly 100% curable. So get thee to a dermatologist, at least once in a while, and send your patients there too. And even the dermatologist may require some reminding of all the time-consuming places melanoma can present: the scalp, between the buttocks, the vulva, between the toes, etc. Some insurance company may even pay for it.

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Comments

  1. I couldn’t agree more. Had a melanoma in situ on my back discovered at a routine annual exam. Dermatologist went back to wedge out the area, found that the shave biopsy had removed it all. Melanoma-free for seven years now. Thank you, routine exam.

  2. Doing this has saved my life twice: in 1993 (on abdomen), and April, 2013 (back). Both melanoma in situs, or, in the words of the path report, “proliferation of atypical melanocytes confined to the epidermis…excellent prognosis”.
    Thank God for competent dermatologists.
    I remember feeling a bit awkward on the first visit when I was asked to remove all my clothes: well worth the scant embarrassment.
    My oldest daughter was 3 at the time the first was removed; 23 now; her 2 younger siblings hadn’t been born yet.

  3. Jason Chao, MD says:

    We need to be evidence based in our recommendations, including prevention and screening. The USPSTF last reviewed screening for skin cancer in 2009 and found insufficient evidence for universal screening in the adult general population. Anecdotes and case reports can be powerful, but are not a substitute for good studies.
    In primary care, spending time on this means less time for something else during a visit. I think most physicians are more selective and trying to identify those at higher risk. Dermatologists who claim they have special expertise need to document the cost-effectiveness of their exams, especially in this era of more restricted health care dollars.

  4. Herbert S. Winston,M.D. says:

    Thank you for the excellent (as usual) advice. I shall make an appointment to be seen by my dermatologist ASAP.

  5. Herb Kleinman says:

    Despite the hype, randomized controlled trials have yet to prove that colonoscopy saves lives, while, ironically, RCTs have been done that show FOBT and flex sig does. Careful analysis of mammography data has also led to the questioning of its life saving benefits. I agree with Dr. Chao. We need to stick with the best evidence that we can when making recommendations about screening.

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