To Improve Melanoma Outcomes, Focus on Risk Stratification, Not Overdiagnosis

The observational study by Matsumoto et al in this issue of JAMA Dermatology is a major contribution to the field of melanoma early detection. The study findings suggest that a screening program performed by primary care clinicians could improve melanoma detection; an additional 17.9 thin melanomas were detected per 100 000 person-years. They also observed 1.2 fewer thick melanomas in the screened vs unscreened group. Although not quite statistically significant, these data suggest a better prognosis for patients who received screening, which is consistent with the authors' earlier findings that melanomas in screened patients were thinner than those in unscreened patients. As the authors noted, there are limitations: the study was not randomized, melanoma depth was not analyzed as a continuous variable, mortality and survival were not determined, and the conclusions only apply to primary care clinicians. However, taken together, we believe these real-world results reflect the promise of screening programs to detect melanoma at an earlier stage and improve patient outcomes.