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Screening and early detection of melanoma

Alan C Geller, RN, MPH
Susan Swetter, MD
Section Editors
Joann G Elmore, MD, MPH
Hensin Tsao, MD, PhD
Deputy Editor
Rosamaria Corona, MD, DSc


The incidence of melanoma of the skin, the most commonly fatal form of skin cancer, is increasing faster than any other potentially preventable cancer in the United States [1]. Five-year survival rates for people with melanoma depend upon the stage of the disease at the time of diagnosis. Survival rates decline steadily as the tumor thickness and disease stage increase. (See "Risk factors for the development of melanoma", section on 'Epidemiology' and "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma", section on 'Prognostic factors affecting staging'.)

Screening for melanoma refers to the routine examination of asymptomatic individuals to identify suspicious lesions that then require further evaluation to establish a diagnosis. The medical literature regarding melanoma screening is complicated by differing types of screening, who is performing the screening, differing target populations, and variations in components of services considered to be "screening." Screening can be directed at all individuals (eg, population-based screening) or targeted to those with specific risk factors. Some studies and discussions of "screening" for melanoma have also included forms of early diagnosis (examination of patients with some concern about a skin lesion) and have incorporated patient education programs in addition to screening [2].

This topic will focus primarily on screening in the context of a clinical examination by a primary care clinician. The topic will review the rationale for screening by skin examination, evidence related to the effectiveness of screening, and recommendations by expert groups. Clinical features of melanoma, risk factors for melanoma, and staging are discussed separately. (See "Clinical features and diagnosis of cutaneous melanoma" and "Risk factors for the development of melanoma" and "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma" and "Inherited susceptibility to melanoma".)

Although the focus of this discussion is on melanoma, skin examination can also detect basal cell and squamous cell carcinomas that require excision, although their prognosis is more favorable than melanoma. (See "Treatment and prognosis of basal cell carcinoma at low risk of recurrence" and "Treatment and prognosis of cutaneous squamous cell carcinoma".)


The incidence of melanoma continues to rise in the United States, similar to trends found throughout most of the world [3]. The estimated age-standardized incidence rates of melanoma in men and women worldwide increased from 2.3 and 2.2/100,000 people, respectively, in 1990 to 21.6/100,000 people in 2012 [4,5]. (See "Risk factors for the development of melanoma", section on 'Incidence'.)


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