EADO Congress 2015

Why is screening for melanoma important?

Prof Iris Zalaudek - Medical University of Graz, Graz, Austria

We are here in Marseilles at a very high powered meeting on melanoma. Why is it important to put screening for melanoma right up front?

Because we have made enormous advances now during the past years with new drugs in treating advanced melanoma but still early detection of skin cancer and melanoma in particular promises the highest cure. So if I diagnose melanoma at a very early stage I have close to 100% cure rate.

What are the main ways that you do this screening then?

Well, screening implies that you do a full body skin examination and, of course, there are several limitations because population based screening showed no benefit. So I should identify in some way persons who are at higher risk to develop skin cancer.

And who are they?

It depends again on age. Screening of children is not useful because children have the lowest risk to develop melanoma; they can develop it but it’s extremely rare and symptoms that are associated in childhood with melanoma are rapidly growing nodules. So if children develop rapidly growing pink or black nodules this is basically the most single important indication to bring the child for a skin cancer examination. The second one in childhood are large nevi that are larger than 1cm in diameter. So also these children should go to a regular follow-up. In adults we know the most single important risk factor for melanoma is a high nevus count and we speak about a high nevus count if we speak about more than 50 nevi. But also there are additional factors that are associated with an increased risk, this is a personal history of melanoma so if a patient had already a melanoma he or she should regularly seek dermatologic examination. But also if there are cases of melanoma in the family or pancreatic cancer these are patients that should go for a regular check.

We were hearing recently that you can get a surrogate for the nevus counting by looking at just the arm, is that a possibility?

This is a very nice marker to look at the nevus count on the arms. It has been shown that if patients have more than twenty nevi on their arms they have a very high likelihood to have also multiple nevi on the trunk and other body sites. So this is a very easy way to screen for people who might be at risk to develop melanoma.

Should you also be looking for people who are likely to be exposed to sun irradiation?

Yes, absolutely. Also patients who had severe sunburns, who had blistering sunburns, also these patients should at least take once in their lifetime a baseline examination assessing eventual additional risk factors and then the doctor will recommend how often they should seek the doctor.

Looking for nevi is very helpful for finding melanoma risk, what about non-melanoma skin cancer? Is that a factor that you’re bearing in mind as well?

Yes, absolutely. If we speak about non-melanoma skin cancer there we speak about elderly people, so older than the age of 50-60, I’m sorry if I define someone elderly like that, but that’s the fact. They are especially men with a fair skin type who were working their life long outside, these are the patients who have the highest risk to develop non-melanoma skin cancer but unfortunately these are also the people who are the minority seeking skin cancer screening programmes. So especially men older than 60 years with a fair skin type, blue eyes, blond hairs, they should regularly go to the doctor.

What are the barriers to actually doing screening? What are the things that prevent doctors from easily doing this?

There are several studies that demonstrated lack of education. So many doctors never were trained in doing or how to perform a skin cancer screening. Here medical universities definitely have a mission to increase the awareness and the way to do it. The other is lack of time; very often doctors say they have no time for that but we did a study where we were measuring actually the time when the patient is naked on the bed, looking how much time it takes to do an examination. Believe it or not it takes not more than three minutes, so this is an argument that should be not any more raised. Other problems are, of course, reimbursement, insecurities, studies basically lacking to show a benefit of population based screening. But definitely we should screen patients who are at risk and we have defined risk factors.

And I can’t let you go away without asking you about, I hope I get this the right way round, Think-Blink-Pink.

Yes, this is a book that I edited which is focussing on dermatoscopy, so this is a non-invasive technique that has been shown to increase significantly the ability of the clinician to diagnose melanoma and skin cancer much earlier than the naked eye. There are many books now on dermatoscopy of pigmented skin tumours but the idea was to provide now also something for non-pigmented skin tumours since they are common, difficult, and I hope we will have a broad readership and they will like it.

In a word, what do you think about when you’re blinking and it’s pink?

If you blink on a pink you have to think, basically, and you have to look at specific criteria which are often vessels, colours and clues. This is the book about it.

So the very brief summary of your interesting approach to screening, a very important approach for doctors, what would you say in a few words?

Try, if you don’t feel confident there are many good things also already on the internet, but don’t be scared to perform it. Do it, try to identify people who are at risk because if you detect cancer early you will save their lives and they will give you a bright smile.