Study: Primary Care Melanoma Screening Does Not Lead to Overtreatment

Melanoma screening in primary care practice does not lead to overtreatment, new research suggests.

In the new study, primary care providers at the University of Pittsburgh Medical Center system received online training in melanoma screening and began looking for the skin cancers in 2014. The training was conducted via the freely available online course INFORMED, which was developed by one of the study authors in 2010.

"The early evidence from this screening effort indicates that melanoma screening coupled with a modified INFORMED training program neither results in large numbers of skin surgeries nor a dramatic increase in visits to dermatologists, which are two potential adverse downstream consequences that have been of concern as a potential basis of morbidity, distress and costs," conclude researchers who were led by Martin Weinstock, MD, professor of dermatology in the Warren Alpert Medical School of Brown University and chief of dermatology at the Providence Veterans Affairs Medical Center in Rhode Island.

The new finding appear in Cancer.

Researchers reviewed the data from tens of thousands of encounters with patients 35 years and older both in the first eight months of 2013 (before the training occurred) and 2014 (after the training occurred).

The researchers also divided care providers into three comparison groups -- one in which about a quarter of providers were trained, one in which only 1 in 11 of the providers were trained, and one in which none were trained.

The study design allowed the team to compare several outcomes both over time and across groups with different degrees of training.

Neither dermatologist visits nor skin surgeries increased substantially between 2013 and 2014 in any of the groups, the study showed. There was also little difference in how often those outcomes occurred between the groups

The lack of major change was not because the training had no effect. Between 2013 and 2014, the group of providers with the most training did produce a 79 percent increase in per-patient melanoma diagnoses. The other groups with less or no training showed no significant increase in diagnoses.

The reason why diagnoses rose significantly in the most trained group but dermatologist visits or surgeries did not is because the number of diagnoses were tiny (24 out of 11,238 patients in 2013 and 48 out of 12,560 patients in 2014). In the same group, in both years, skin surgeries numbered in the hundreds and dermatologist visits numbered in the thousands. There are many reasons why both of those could occur independently of melanoma. This suggests that newly diagnosed melanoma patients could well have received the proper follow-up care that their diagnoses warranted without radically changing the overall number of dermatologist visits or surgeries.

In a follow-up study, the team plans to analyze metrics of whether screening resulted in significantly greater distress for patients. That will be a test not only of whether primary care screening has that unintended result, but also of whether the INFORMED course is successful in training providers to not only spot cancers, but also reassure patients when lesions are benign.