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

## TL;DR

Screening children and adolescents for skin cancer saves few lives but leads to many unnecessary biopsies due to low disease prevalence and unclear symptoms.

## Contribution

This study quantifies the inefficiency of CMM screening in children and adolescents using real-world data from northern Italy.

## Key findings

- Only 0.4% of total CMM cases occurred in children and adolescents.
- The number needed to biopsy to detect a case was 681.5 in children versus 66.4 in middle-aged adults.
- Potential life-years saved in children were 0.03 times that of middle-aged adults.

## Abstract

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.

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.

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).

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.