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

Lauro Bucchi¹Silvia Mancini¹Pietro Ceretti²Federica Zamagni¹Emanuele Crocetti¹LUIGINO DAL MASO³Stefano Ferretti⁴Flavia Baldacchini¹Orietta Giuliani¹Alessandra Ravaioli¹Rosa Vattiato¹Giuliano Carrozzi⁵Maria Michiara⁶Antonino Musolino¹Fabio Falcini¹Ignazio Stanganelli^1*

• ¹IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
• ²Universita degli Studi di Parma, Parma, Italy
• ³Centro di Riferimento Oncologico IRCCS, Aviano, Italy
• ⁴Universita degli Studi di Ferrara, Ferrara, Italy
• ⁵Azienda Unita Sanitaria Locale di Modena, Modena, Italy
• ⁶Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

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 endpoint were in situ/invasive CMM incidence rate, Breslow tumour 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.