Structured surveillance program may have utility in high-risk melanoma

A large-scale surveillance program may allow clinicians to detect melanomas earlier in high-risk patients, according to a study.

“A previous single-center study observed fewer excisions, lower health care costs, thinner melanomas and better quality of life when surveillance of high-risk patients was conducted in a melanoma dermatology clinic with a structured surveillance protocol involving full-body examinations every 6 months aided by total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI),” Pascale Guitera, MD, PhD, of the Melanoma Institute Australia at the University of Sydney and of the Sydney Melanoma Diagnostic Centre at Royal Prince Alfred Hospital, and colleagues wrote.

In the prospective cohort study, the researchers aimed to assess the longer-term sustainability of expanding such a program to multiple sites, including a primary care skin cancer clinic.

The analysis included 593 participants at high risk for melanoma recruited at four sites in Australia between 2012 and 2018; 57.3% of the cohort were men, with a baseline age of 58 years. Follow-up lasted a median of 2.9 years.

Full-body examinations were conducted using TBP and SDDI every 6 months. SDDI was performed at 3 months or 6 months in patients with equivocal lesions.

Incidence and characteristics of new lesions served as the key endpoint, along with association between diagnostic tools and rates of detecting novel melanomas.

Overall, the researchers observed 1,513 lesions, including 171 primary melanomas.

Results showed an overall excision ratio of benign to malignant carcinomas of 0.8-1.0. This included keratinocyte carcinomas.

The ratio of benign melanocytic excisions to melanoma excisions was 2.4-1.0, while the ratio for melanoma in situ to invasive malignancy was 2.2-1.0.

The researchers observed no differences in these ratios across the four study sites.

During the first 2 years of follow-up, participants experienced a 9% annual risk for developing a new melanoma. This risk increased over time, particularly among patients who developed multiple primary melanoma malignancies.

There were seven melanomas with a Breslow thickness greater than 1 mm (4.1% of all melanomas). Of these seven cases, four were desmoplastic or nodular, two were self-detected and three were clinician detected without using TBP.

New melanomas were the cases most likely to be detected by a clinician using TBP, at 31.6%. Digital dermoscopy monitoring was used to detect 29.2% of cases.

“The structured surveillance program for high-risk patients may be implemented at a larger scale given the present cohort study findings suggesting the sustainability and replication of results in numerous settings, including a primary care skin cancer clinic,” the researchers wrote.