A magazine for friends of the Warren Alpert Medical School of Brown University.

Do No Harm


Would more melanoma screenings mean more unnecessary tests and treatments?

Malignant melanoma kills about 10,000 people in the US every year, but it can be cured if caught early. While some experts are calling for widespread training of primary care providers to screen patients during routine visits, others worry that could lead to misdiagnoses, overtreatment, and unnecessary patient distress. A team of researchers led by Martin Weinstock, MD, PhD, professor of dermatology at Alpert Medical School and chief of dermatology at the Providence Veterans Affairs Medical Center, studied what happened when PCPs in the University of Pittsburgh Medical Center system gained online training in melanoma screening and began looking for the skin cancers in 2014. They reported their findings in Cancer in July.

Weinstock’s team reviewed the data from tens of thousands of encounters with patients 35 years and older both in the first eight months of 2013, before the training occurred, and after, in 2014. When they divided PCPs into three comparison groups based on how much training they received, they found that neither dermatologist visits nor skin surgeries increased substantially between 2013 and 2014 in any of the groups. Between the groups there was also little difference in how often those outcomes occurred.

The lack of major change was not because the training had no effect. Between 2013 and 2014, the group of providers with the most training produced a 79 percent increase in per-patient melanoma diagnoses, but the number of diagnoses was tiny (24 out of 11,238 patients in 2013, and 48 out of 12,560 patients in 2014). In the same group, in both years, skin surgeries numbered in the hundreds and dermatologist visits in the thousands. There are many reasons why both of those could occur independently of melanoma.

In other words, the newly diagnosed melanoma patients could well have received the proper follow-up care that their diagnoses warranted without radically changing the overall number of dermatologist visits or surgeries. And there was no sign that training PCPs to screen for melanoma had flooded dermatologists or surgeons with torrents of cases.


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