Digital surveillance, photography aided early melanoma diagnosis

Surveillance with total body photography and sequential digital dermoscopy imaging helped improve early detection of primary melanomas, according to study results.

“Whereas encouraging vigilance and self–skin examination is important, there is increasing evidence that interventions such as dermoscopy, sequential digital dermascopic imaging, and baseline total-body photography can aid early detection of melanoma,” Fergal J. Moloney, MD, of the University of Sydney at Sydney Cancer Center in Australia, and colleagues wrote.

To determine the impact of full-body examinations on melanoma detection, the researchers enrolled 311 patients (179 men, 132 women) seen at the Sydney Diagnostic Centre and Melanoma Institute Australia.

Eligible patients included those with:

A personal history of invasive melanoma and dysplastic nevus syndrome;
A personal history of at least one invasive melanoma and a family history of invasive melanoma in at least three first-or second-degree relatives;
A personal history of at least two primary invasive melanomas, with one of these occurring within 10 years before study enrollment; or
A confirmed CDKN2A or CDK4 gene mutation.

Moloney and colleagues collected patient data at baseline, including a mole count and dermoscopic evaluation of suspicious moles. All atypical lesions were excised.

Lesions considered suspicious but not conclusively known to be melanoma were monitored using short-term (3 months) sequential digital dermoscopy imaging. Less suspicious atypical nevi were monitored through long-term (6 months) digital imaging.

Total body photography was performed at baseline on all participants, and the photographs were provided to the patients. Patients were taught how to perform photography, and they were instructed to perform full body skin self-examinations at 3 months, and also 1 day prior to the 6-month follow-up.

At each follow-up visit, patients were asked to discuss observations and changes noted through photography or self-exam. Researchers performed a full clinical and dermascopic skin examination and compared the results to the baseline exam. The researchers also noted which lesions were detected with the assistance of photography or exclusively through photography.

According to study results, during median follow-up of 3.5 years (interquartile range, 2.4-4.2 years), the researchers detected 75 primary melanomas, 14 of which were detected at the baseline visit.

Fifty-one of the primary melanomas (68%) developed in men, and 24 primary melanomas (32%) developed in women. The median Breslow thickness of incident melanomas detected after baseline was in situ to 0.6 mm. Of the melanomas identified, 38% percent were detected with total body photography and 39% were detected with digital imaging.

Five melanomas had Breslow thickness >1 mm. Three were of a desmoplastic histological subtype, and two had nodular characteristics.

Moloney and colleagues determined the following benign-to-malignant excision rations: 1.6:1 for all lesions removed; 2.2:1 for the dysplastic nevus syndrome group; 1.8:1 for the strong family history group; 1.1:1 in the multiple primary melanomas group; and 1.6:1 in the gene mutation carrier group. Of the total 770 lesions excised, 441 were melanocytic lesions, signifying a 4.4:1 benign melanocytic-to-melanoma ratio.

The aggregate risk of novel primary melanoma onset was 12.7% at 2 years. New primary melanoma incidence during the last 3 years of follow-up was half the number detected in the 2 two years (incidence density ratio, 0.43; 95% CI, 0.25-0.74).

Allan C. Halpern

The findings underscore the importance of innovation and new approaches in the detection of melanoma, Allan C. Halpern, MD, chief of the dermatology service at Memorial Sloan Kettering Cancer Center and a HemOnc Today Editorial Board member, wrote in an accompanying editorial.

“The ability to manage the growing and costly epidemic of skin cancer more efficiently will likely require new diagnostic and therapeutic strategies, as well as engagement of other health care providers, such as nurse practitioners, physician assistants and family physicians,” Halpern wrote. “While we await more data on the risks, benefits and costs of population-based melanoma screening, greater efforts are indicated toward improving the identification and technologically assisted surveillance of patients at high risk of melanoma.”

For more information:

Moloney FJ. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.514
Halpern AC. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.513.

Disclosures: Halpern serves as a scientific adviser to Canfield Scientific Inc. and Lucid Inc.