Melanoma Screening Yield Is High for Older, At-Risk Men

NEW YORK—Among men over age 50 with an additional melanoma risk factor, diagnostic yield of melanoma screening is 1 in 219, data from the American Academy of Dermatology (AAD) National Skin Cancer Screening Program show. That yield is high, suggesting the potential cost-effectiveness of this intervention, according to Barbara A. Gilchrest, MD, professor and chairman of dermatology, Boston University.

"The insurance industry accepts that mammography is well worth the expense to reduce breast cancer mortality," Dr. Gilchrest said at an AAD press conference, "and the yield in this group of men over 50 with an additional risk factor is exactly the same order of magnitude."

Men as a group, and perhaps older men in particular, are not as likely as women to self-examine the skin and presumptively diagnose their own diseases, making screening programs for men particularly important, Dr. Gilchrest said.

She reported on screenings conducted by volunteer dermatologists between 1992 and 1994. Screening included individuals suspicious they were at high risk, worried about a specific lesion, or generally concerned about developing skin cancer. The entire skin surface was briefly examined, and the individual was advised whether follow-up was needed.

A total of 364 persons (1 in 666) had a confirmed melanoma diagnosis. By comparison, the overall risk of melanoma in adult Americans is less than 1 in 4,000 annually. More than three quarters of melanomas detected were in the early stages, either in situ or less than 0.76 mm in thickness.

Men over 50 comprised only 25% of screened persons, but had 44% of confirmed melanomas. Men, overall, comprised 40% of all persons screened but had 58% of confirmed melanoma cases.

Also more likely to have melanoma were persons reporting a changing mole or who had one or more of the established risk factors (skin type I/II, personal or family history of skin cancer).

"If we want to preserve life, and prevent deaths from this terrible disease, we need to diagnose it early," Dr. Gilchrest said. "We need people to be aware of their risk factors, and to seek attention when they have a changing mole or any other reason to be concerned there might be a melanoma in their skin."

The AAD estimates there will be 51,400 new cases of melanoma in the United States for 2001, with about 7,800 deaths from the disease (5,000 men and 2,800 women). Early-stage melanoma is highly treatable, with surgical removal curative in most cases.

Darrell S. Rigel, MD, of New York University, said that current melanoma awareness programs may be less effective in reaching men. "The message we have been sending out has been primarily oriented toward women, through health and fashion magazines, and women tend to adopt healthful behaviors faster than men," he said.

The AAD recommends that persons with melanoma risk factors conduct a monthly self-examination of their entire skin surface, enlisting the assistance of a spouse, family member, or friend to examine hard-to-see areas such as the middle back.

Roger I. Ceilley, MD, co-chair of the AAD’s communications council, said that at-risk persons also should have a yearly exam by a dermatologist, with particular scrutiny of larger-diameter moles.