One-time Melanoma Screening

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It’s not exactly beach weather this time of year, but melanoma is on the mind of medical researchers this week with an unusual message. Maybe it’s OK to get screened for skin cancer, just once in your life! Or… is it? If you’re a number cruncher, looking at whether the lives you’re saving by detecting x number of cancers is worth y numbers of dollars, then yes, this is a study perhaps up for discussion—one that would make the argument that Dr. Ariel Ostad and the American Academy of Dermatology have it all wrong. “The current recommendations are to have a yearly skin exam. To see your dermatologist once a year, to reduce your incidence of melanomas and certainly save lives,” says Dr. Ostad, a dermatologic surgeon at NYU School of Medicine. I’m sorry, that just doesn’t add up dollar wise, doctor. This latest study in the well respected Archives of Dermatology, says, you can save a lot of money if you get a skin screen just once by a doctor--at the age of fifty or older. One time screening… at age 50????!!!!!

Dr. Ostad says, “It is the leading cause of death between 18 and 29. By seeing a dermatologist on an annual basis you can actually detect melanomas earlier and catch them at an earlier stage and save lives. The flaw with the study is that if you wait that long to see the dermatologist you could potentially die of a melanoma much earlier, before you reach 50 years old.”

Using mathematical models, the authors certainly figured out that annual visits to the doctor--which does save more lives-- are much more costly than just going once. The authors make the argument for people to screen themselves after being taught how to do so, .and not go to the doctor. David Friedman used to be a sun worshiper when he was younger. “I have beauty spots, I decided to have a checkup,” says David.

Not cost effective, but….“I came to get one taken off. And he sent it away and it was melanoma.” But lifesaving! It was caught before it had spread. Still, the United States Preventive Services Task Force in 2001 concluded that "Evidence is lacking that skin examination by clinicians is effective in reducing mortality or morbidity (disease). The Institute of Medicine reached similar conclusions.

Dr. Ostad says, “That is absolutely a disservice to the patient because if the doctor is not involved in doing the screening there are going to be tremendous number of cases of melanoma that get undiagnosed and undetected and it leads to early demise of the patient.” Someone’s wrong. Fortunately for David, he made that—“wrong” decision to see the doctor before he was 50.

The argument is that there are no good studies documenting the effectiveness of screening for skin cancer. Still, Dr. Ostad says it’s important to get your skin examined every year, especially at a younger age, especially if your fair skinned, you have blonde hair and blue eyes, especially if you’ve had sunburns in the past, and especially if you have a family history of melanoma.

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