Introduction
The need to establish evidence-based skin cancer screening is paramount. Risk-stratified intervals has potential to improve efficiency, cost-effectiveness and minimize unnecessary healthcare resource strain.
Aim
To assesses screening appointments (SA) per keratinocyte carcinomas (KC), incidentally diagnosed in the ‘Tailored Surveillance’ targeted melanoma screening project.
Method/Description
A prospective cohort study was conducted from 08/02/2021 to 31/07/2022 with follow up until 31/07/2023. Prospective risk-stratified skin check intervals were implemented, and through retrospective clinical record review, screening appointments for melanomas and KC were analysed. Study eligibility included ≥18 years old, English-proficient, and minimum 12-months follow-up. Participants undertook an online risk-assessment which provided skin-check frequency recommendations based on estimated melanoma ten-year risk (Table 1).
Results
This study had 591 participants with primary cutaneous melanomas (n=102) diagnosed in 75 patients during the follow-up period. 458 KCs (339 BCCs and 119 SCCs) were diagnosed with the recommended SA/melanoma and SA/KC displayed in Table 1.
Table 1:
| Cohort | Ten-YEAR MELANOMA RISK | SCREENING FREQUENCY | Number of melanomas diagnosed | SA per Melanoma | Number of KC Diagnosed | SA per KC | |
| No previous melanoma | <10% | Nil – Lesion of concern only | 4 | 0 | 33 | 0 | |
| <10% + dysplastic naevus syndrome
|
12-monthly | 3 | 32 | 10 | 10 | ||
| 10-24% | 12-monthly | 4 | 35 | 62 | 2 | ||
| previous melanoma | <10% | 12-monthly | 0 | 0 | 1 | 7 | |
| 10-24% | 12-monthly | 29 | 20 | 90 | 6 | ||
| 25-74% | 6-monthly | 24 | 20 | 99 | 5 | ||
| >75% | 4-monthly | 41 | 16 | 173 | 4 | ||
Consclusions
This study explores risk-stratified screening intervals in a melanoma project and the incidental detection of KCs during follow-up. KCs do not qualify for screening due to rare fatality, yet overlapping risk factors with melanomas will undoubtably result in identification during melanoma screening. Diagnosis and treatment of KCs are likely to inflate melanoma screening costs. Whilst early detection may reduce morbidity, there remains a risk of unnecessary treatment of indolent tumours. This can help guide a national screening program.