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Catherine M Olsen, Catherine M Olsen Cancer Control Group Faculty of Medicine, The University of Queensland , Queensland , Australia Correspondence: Catherine M. Olsen. Email: Catherine.Olsen@qimrberghofer.edu.au Search for other works by this author on: Oxford Academic Louisa G Gordon Faculty of Medicine, The University of Queensland , Queensland , Australia Health Economics Group, QIMR Berghofer Medical Research Institute , Queensland , Australia Queensland University of Technology (QUT), School of Nursing, Institute of Health and Biomedical Innovation , Brisbane, Queensland , Australia Search for other works by this author on: Oxford Academic Stacy M Carter Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, The University of Wollongong , New South Wales , Australia Search for other works by this author on: Oxford Academic David C Whiteman Cancer Control Group Faculty of Medicine, The University of Queensland , Queensland , Australia Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0003-4483-1888 British Journal of Dermatology, Volume 188, Issue 6, June 2023, Pages 798–799, https://doi.org/10.1093/bjd/ljad055
Published:
03 March 2023
Article history
Received:
27 October 2022
Revision received:
21 February 2023
Accepted:
28 February 2023
Published:
03 March 2023
Corrected and typeset:
18 April 2023
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Catherine M Olsen and others, The ethical implications of opportunistic detection of melanoma in clinical care, British Journal of Dermatology, Volume 188, Issue 6, June 2023, Pages 798–799, https://doi.org/10.1093/bjd/ljad055
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https://doi.org/10.1093/bjd/ljad055
Population-based screening for melanoma is not currently recommended because there is insufficient evidence that the benefits outweigh the harms.1 Instead, early detection mostly takes place opportunistically, via skin checks offered or requested in a doctor–patient encounter. This has led to a notable rise in the detection of in situ and thin melanomas, without a proportionate decrease in incidence of thicker melanomas or a decline in melanoma mortality. This appears to provide evidence for overdiagnosis (the detection of cancers through screening that would not have caused significant morbidity or mortality within a person’s lifetime).2 Given this, we sought to appraise the ethical implications of opportunistic detection of melanoma.
The accepted criteria for evaluating screening programmes include that screening should be beneficial to both individuals and to the community, and that harms should be minimized or avoided.3 In population-based cancer screening programmes (e.g. breast, colorectal), a policy is developed and implemented after explicitly accounting for the balance of benefits and harms. In contrast, for opportunistic cancer detection (e.g. prostate, skin), the decision whether or not to screen is made by thepractitioner and patient. Evaluating the balance of benefits and harms of melanoma detection is challenging because no randomized screening trials have been conducted, and thus population-level data on potential benefits or harms are lacking. We recognize that widespread opportunistic melanoma detection approximates population screening, such that an ethics analysis utilizing concepts, values and principles of public health ethics analysis would be valuable. However, because skin checks currently occur in the context of individual doctor–patient clinical encounters, we focus on the ethical implications using Beauchamp and Childress’s principles of clinical medical ethics: beneficence, nonmaleficence, autonomy, and justice.4
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