[Melanoma prevention - to screen or not to screen?]

Abstract

Melanoma is one of the most common cancers worldwide with a high mortality rate. However, the smaller the melanoma is when it is first diagnosed, the better the prognosis. Since skin melanomas can be detected relatively easy with the naked eye, systematic skin cancer screening could theoretically reduce melanoma mortality by diagnosing it as early as possible. Evaluations of skin cancer early detection programs show an increase in the incidence of detection of the skin cancer and especially thins melanomas, but so far, no evidence of a decrease in mortality. Current data on patient-related factors show that fewer men and people with lower socioeconomic status participate in skin cancer screening and knowledge about skin cancer-associated factors is low.Based on the current study situation, it is therefore not possible to recommend or advise against skin cancer screening for the asymptomatic population. Screening is recommended for all people at increased risk: fair skin type according to Fitzpatrick I-II, under immunosuppression, more than 50 melanocytic nevi and history of dysplastic and/or large nevi, family history of melanoma, frequent severe sunburns in childhood. In addition, targeted educational campaigns among risk groups (men, people with low levels of education) are needed.New imaging techniques such as 3D whole-body photography with additional computer-based, AI-assisted risk assessment of digital dermoscopic images, when integrated into clinical decision-making processes (as "augmented intelligence" - AI), clearly have the potential to improve skin cancer screening, particularly in high-risk and melanoma patients. In combination with human expertise, they can potentially offer a more effective and comprehensive approach to detecting and monitoring skin cancer. Randomized controlled studies must show to what extent this promising technique has proven itself in the clinic and is also suitable for other populations.