Melanom-Screening

Deutschland ist weltweit das einzige Land mit einem Hautkrebs-Screening für alle Personen ab 35 Jahren. Ob dieses tatsächlich die Hautkrebsmortalität der Allgemeinbevölkerung senkt, ist jedoch bisher nicht nachgewiesen, wie dieser Beitrag zeigt. Darüber hinaus stellt er neue bildgebende Verfahren und die Risikobewertung von Hautläsionen durch künstliche Intelligenz vor – Technologien, die zukünftig wohl eine große Rolle spielen werden.

Abstract

Melanoma is one of the most common cancers worldwide with a high mortality rate. However, the smaller the melanoma is when it is first diagnosed, the better the prognosis. Since skin melanomas can be detected relatively easy with the naked eye, systematic skin cancer screening could theoretically reduce melanoma mortality by diagnosing it as early as possible. Evaluations of skin cancer early detection programs show an increase in the incidence of detection of the skin cancer and especially thins melanomas, but so far, no evidence of a decrease in mortality. Current data on patient-related factors show that fewer men and people with lower socioeconomic status participate in skin cancer screening and knowledge about skin cancer-associated factors is low.

Based on the current study situation, it is therefore not possible to recommend or advise against skin cancer screening for the asymptomatic population. Screening is recommended for all people at increased risk: fair skin type according to Fitzpatrick I–II, under immunosuppression, more than 50 melanocytic nevi and history of dysplastic and/or large nevi, family history of melanoma, frequent severe sunburns in childhood. In addition, targeted educational campaigns among risk groups (men, people with low levels of education) are needed.

New imaging techniques such as 3D whole-body photography with additional computer-based, AI-assisted risk assessment of digital dermoscopic images, when integrated into clinical decision-making processes (as “augmented intelligence” – AI), clearly have the potential to improve skin cancer screening, particularly in high-risk and melanoma patients. In combination with human expertise, they can potentially offer a more effective and comprehensive approach to detecting and monitoring skin cancer. Randomized controlled studies must show to what extent this promising technique has proven itself in the clinic and is also suitable for other populations.

Kernaussagen

• Deutschland ist weltweit das einzige Land mit geregeltem Hautkrebs-Screening.

• Flächendeckendes Screening führt zur vermehrten Detektion von Melanomen in frühen Stadien, senkt jedoch bisher nicht nachweislich die Sterblichkeit.

• Männer und Gruppen mit niedrigem sozioökonomischem Status nehmen seltener an Screening-Untersuchungen teil – gezielte Aufklärung ist erforderlich.

• Ein allgemeines Hautkrebs-Screening für asymptomatische Personen kann anhand der aktuellen Datenalge derzeit weder empfohlen noch ausgeschlossen werden – Risikopatienten sollten jedoch gescreent werden.

• Zur Überprüfung der Wirksamkeit eines flächendeckenden Hautkrebs-Screenings in der Allgemeinbevölkerung sind zukünftig randomisierte kontrollierte Studien notwendig.

• Kommerzielle Smartphone-Apps zur Beurteilung von melanozytären Hautveränderungen führen häufig zu überhöhten Risikoeinschätzungen.

• KI-gestützte 3D-Ganzkörperfotografie und digitale Dermatoskopie haben in Kombination mit menschlicher Expertise das Potenzial zur Verbesserung des Screenings, besonders für Hochrisikopatienten.

Schlüsselwörter

Melanom - Screening - Prävention - Künstliche Intelligenz - Ganzkörperfotografie

Keywords

melanoma - screening - prevention - artificial intelligence - total-body photography

Publication History

Article published online:
22 April 2025

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