Positive Effect on Prognostic Factors

Letters to the Editor Skin Cancer Screening and Medical Treatment Intensity in Patients with Malignant Melanoma and Non-Melanocytic Skin Cancer A Study of AOK Insurees in the First Year After Diagnosis 2014/2015 by Dr. med. Katrin Schuldt, Dr. med. vet. Pietro Trocchi, Hildegard Lax, Dr. rer. medic. Dipl.-Inf. Michael Nonnemacher, Dipl.-Math. Christian Günster, M.Sc. Kathrin Pahmeier, M.Sc. Christian Speckemeier, Dr. PH Silke Neusser, Prof. Dr. rer. pol. Jürgen Wasem, and Prof. Dr. med. Andreas Stang, MPH in issue 3/2023

The authors present an interesting analysis regarding the positive effects of the German skin cancer (SKS) screening program on the treatment intensity in melanoma and non-melanocytic skin cancer (NMSC) (1). But not only should the treatment intensity reduce as a result of screening, but—with a delay—mortality should also reduce (2). In a recent article in the British Journal of Dermatology (3), based on data from the AOK PLUS from 2010 to 2016, we showed for AOK PLUS beneficiaries from Saxony (2.1 million, about 50% of the regional population) a mortality reduction in participants in SCS in whom (during or after the screening) a melanoma was diagnosed. We analyzed data from 4552 persons with prevalent melanoma and 2475 persons with incident melanoma. Persons who participated in screening had a lower mortality risk than persons who had not undergone screening. The crude absolute risk of death for persons who participated in screening and who were diagnosed with a melanoma (9.5%) was more than 50% lower than that of people who had not participated in screening (22.8%). The fully adjusted Cox model with lead time bias yielded a hazard ratio of 0.75 (95% confidence interval [0.49; 1.17]). A lead time of one year resulted in a non-significant point estimator because of the lower case number, but a positive effect of skin cancer screening for survival was indicated.

We estimated the number needed to screen to prevent one death within 4 years (mean 660.5 days) as 8321 persons [7.561; 9.249].

Altogether, our results are consistent with the analyses presented by Schuldt et al. and indicate a positive effect of the German skin cancer screening program for prognostic factors and mortality due to melanoma.

DOI: 10.3238/arztebl.m2023.0081

Dr. rer. nat. Thomas Datzmann, Prof. Dr. med. Jochen Schmitt

Nationales Centrum für Tumorerkrankungen, Dresden

Deutsches Krebsforschungszentrum (DKFZ), Heidelberg

Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus,

Technische Universität Dresden

Helmholtz-Zentrum Dresden – Rossendorf (HZDR), Dresden

TU Dresden, Medizinische Fakultät Carl Gustav Carus

Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden

Dr. rer. nat. Olaf Schoffer

TU Dresden, Medizinische Fakultät Carl Gustav Carus

Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Schuldt K, Trocchi P, Lax H, et al.: Skin cancer screening and medical treatment intensity in patients with malignant melanoma and non-melanocytic skin cancer—a study of AOK insurees in the first year after diagnosis, 2014/2015. Dtsch Arztebl Int 2023; 120: 33–9

2. Eisemann N, Waldmann A, Garbe C, Katalinic A: Development of a microsimulation of melanoma mortality for evaluating the effectiveness of population-based skin cancer screening. Med Decis Making 2015; 35: 243–54

3. Datzmann T, Schoffer O, Meier F, Seidler A, Schmitt J: Are patients benefiting from participation in the German skin cancer screening programme? A large cohort study based on administrative data. Br J Dermatol 2022; 186: 69–77