Dermatologists recommend risk-based skin cancer prevention instead of universal screenings

Study evidence supports the course change

According to the ÖGDV, a higher risk exists, among other factors, in cases of familial occurrence of melanomas, previously occurring actinic keratosis, cutaneous squamous cell carcinoma or basal cell carcinoma – the two most common forms of non-melanoma skin cancer – as well as in people who have received an organ transplant. The professional society recommends self-examinations instead of routine dermatological check-ups for persons with more than 60 acquired moles, more than 4 atypical moles, or previously occurring melanomas. For all others, the ÖGDV recommends self- and partner examinations for adults aged 18 and over.

The ÖGDV justifies its course change with the study evidence. "Internationale Studien konnten nicht zeigen, dass durch ungezielte Screenings und Vorsorgeprogramme die Sterblichkeit durch Hautkrebs gesenkt werden konnte", it stated. ÖGDV Vice President Franz Trautinger, Head of the Department of Dermatology and Venereal Diseases at the University Hospital St. Pölten, said: "Vielmehr gab es in den vergangenen zehn Jahren zunehmend Publikationen, die die Sinnhaftigkeit eines ungezielten Screenings in Frage gestellt haben". The professional society also expressed reservations about the use of apps for skin monitoring: "Das Problem der Apps ist, dass es keine großen Studien gibt, die Genauigkeit und Verlässlichkeit bestätigen."

Manfred Fiebieger, Federal Specialist Group Chairman for Dermatology of the ÖGDV, summed up the basic idea in a formula: "Es bedeutet die richtige Medizin für die richtigen Menschen zur richtigen Zeit". Dermatologists, general practitioners, social insurance, the ministry, the medical chamber, cancer aid organizations, and patient representatives are to work together on a nationwide model. The ÖGDV sees an opportunity for Austria to find a middle path: "Prävention für alle, Aufmerksamkeit für auffällige Veränderungen und gezielte Früherkennung für Menschen mit erhöhtem Risiko."

Sun protection remains central

According to the ÖGDV, Germany occupies a special position in Europe: there, those with statutory insurance can take advantage of a screening every two years from age 35. In Austria, such a universal regulation has not yet been established. Kölblinger emphasized: "Wir geben daher zum jetzigen Zeitpunkt keine eindeutige Empfehlung" – while at the same time pointing to the political and societal will to further develop prevention.

The ÖGDV continues to attach high importance to primary prevention. Recommended are sun protection through clothing, sunscreen with a sun protection factor of at least 30, and avoiding the midday sun, i.e., two hours before and after the sun's peak. "Vor allem beim Thema UV-Schutz bestehe noch 'Luft nach oben', viele Menschen wüssten nicht, welche Schäden sie mit Sonnenbaden anrichten", according to the professional society. In addition, direct sun should be avoided between 11 a.m. and 3 p.m. As a rough guideline, the ÖGDV cited: after one week of summer vacation, a 200-milliliter tube of sunscreen should be used up.

Epidemiology in Austria

The background to the new recommendations is the epidemiological situation: around 400 to 450 people die from melanomas in Austria each year. Melanomas can form metastases in 2 to 5 percent of cases, particularly in lymph nodes. More targeted early detection is therefore intended to reach precisely those individuals whose risk is above average. According to the ÖGDV, self-examination – and mutual observation by a partner – remains the central element of prevention for most adults.

Dermatologists, general practitioners, social insurance, the ministry, the medical chamber, cancer aid organizations, and patient representatives are to work together on a nationwide model. "Die Hautkrebsvorsorge soll nicht nach dem Gießkannenprinzip erfolgen, sondern nur bei jenen, die es wirklich brauchen", the ÖGDV emphasized. When the announced national model will actually be available is currently open.