In this study, researchers estimated strategies to treat metastatic melanoma have undergone a fundamental paradigm shift. Targeted therapies and more recently immunomodulatory agents have largely replaced unspecific cytotoxic chemotherapies.
These new mechanism-based therapies have demonstrated an improved overall survival in patients with metastatic melanoma and, in a small proportion of patients, even induce long-lasting treatment responses.
Yet immunomodulatory therapies are frequently associated with severe side-effects, and the overall long-term survival rate for most patients remains low. In contrast, if melanoma has not yet spread to other organs, surgical removal is usually curative. Consequently, early recognition of melanoma, before metastasis, is central to reducing morbidity and mortality.
In this editorial, we summarize some important epidemiological and clinical studies on melanoma published in the BJD in the recent years. Firstly, we will focus on studies that aim to detect melanoma early before spreading to other organs and later we discuss studies investigating the treatment strategies for metastasized melanoma.
Screening programmes to identify malignancies early can significantly reduce cancer mortality. In 2008, Germany implemented a nationwide skin cancer screening programme. To gain insights into its effectiveness.
Researchers investigated the utilization and outcomes of the German screening programme in Saxony, a federal state in Germany with a population of more than 2 million people. The annual participation rate was approximately 12% among eligible individuals aged ≥ 35 years. No significant changes were found in the melanoma incidence and mortality of participants vs. nonparticipants.
The authors refrained from drawing any final conclusions, because longer follow-up and linkage with clinical data are necessary to clarify the effects of the German skin cancer screening programme on the incidence and prognosis of melanoma. Nevertheless, it seems likely that broad screening programmes of unselected populations might not be as efficient as targeting specific individuals at higher risk of melanoma.
To identify high-risk patients efficiently, author approached more than 9000 patients in the waiting rooms of general practitioners in Great Britain. More than 85% of the participants assessed their melanoma risk by completing an electronic questionnaire on a tablet computer.
When the authors stratified the 20% of patients with the highest melanoma risk score in a group, they could predict that 60% of patients in this high-risk group would be diagnosed with melanoma at any time in the future and that 3% would develop melanoma in the next 5 years.
The authors concluded that assessing the patient's melanoma risk while waiting for a physician's appointment is both feasible and acceptable for patients. These worldwide efforts to improve melanoma therapy and to identify individuals with an increased melanoma risk have already contributed to improved overall survival in patients with melanoma.
However, there is still much to be done, and future efforts should be directed to all aspects of melanoma therapy from improved early recognition of melanoma to prolonging disease control and providing better access to palliative care.