Screening children and adolescents for cutaneous malignant melanoma: the impossible trade-off between life-years saved and unnecessary biopsies

Introduction: In Europe, insufficient data exist to assess the magnitude and results of screening practice for cutaneous malignant melanoma (CMM) among children and adolescents. In this population-based study covering part of the Emilia-Romagna Region (northern Italy), multiple indicators of screening for CMM by patient age were evaluated. Methods: The current population of the study area is over 2,600,000. The records of patients with CMM (2003-2017) were extracted from the Emilia-Romagna Cancer Registry. The records of dermatologic office visits and skin biopsies were downloaded from the outpatient healthcare database of the Regional Administration. Patient age was grouped as 0-19 (children and adolescents), 20-39, 40-59, 60-79, and ≥80 years. The study endpoints were in situ/invasive CMM incidence rate, Breslow tumor thickness distribution, mortality rate, dermatologic office visit rate, skin biopsy rate, number (of patients) needed to visit (NNV) and biopsy (NNB) to detect a case of disease, and the potential number of life-years saved, equivalent to the number of years of life expectancy left at diagnosis. Results: Data for 11,679 patients, 4,593,988 dermatologic office visits and 849,343 skin biopsies were obtained. Patients aged 0-19 years (n=51) accounted for 0.4% of total incident CMM cases, 0.3% of total deaths from CMM, and 1.4% of total potential number of life-years saved. The annual dermatologic office visit rate at age 0-19 years was 9.2%. The NNV was 11,362.2 at age 0-19 years versus 305.6 in the middle-aged group of 40-59 years (ratio, 37.2). The NNB was 681.5 and 66.4, respectively (ratio, 10.3). The total potential number of life-years saved was 2939.9 versus 98,382.2, respectively (ratio, 0.03). Conclusion: When screening children and adolescents for CMM, a trade-off between life-years saved and unnecessary biopsies is impossible to make because of the minimal prevalence and the ill-defined clinical/dermoscopic features of the disease.