Efficiency of Detecting New Primary Melanoma Among Individuals Treated in a High-risk Clinic for Skin Surveillance

Abstract

IMPORTANCEA 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).OBJECTIVE To examine longer-term sustainability and expansion of the surveillance program to numerous practices, including a primary care skin cancer clinic setting. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study recruited 593 participants assessed from 2012 to 2018 as having very high risk of melanoma, with a median of 2.9 years of follow-up (interquartile range, 1.9-3.3 years), from 4 melanoma high-risk clinics (3 dermatology clinics and 1 primary care skin cancer clinic) in New South Wales, Australia. Data analyses were conducted from February to September 2020.EXPOSURES Six-month full-body examination with the aid of TBP and SDDI. For equivocal lesions, the clinician performed SDDI at 3 or 6 months. MAIN OUTCOMES AND MEASURESAll suspect monitored or excised lesions were recorded, and pathology reports obtained. Outcomes included the incidence and characteristics of new lesions and the association of diagnostic aids with rates of new melanoma detection. RESULTS Among 593 participants, 340 (57.3%) were men, and the median age at baseline was 58 years (interquartile range, 47-66 years). There were 1513 lesions excised during follow-up, including 171 primary melanomas. The overall benign to malignant excision ratio, including keratinocyte carcinomas, was 0.8:1.0; the benign melanocytic to melanoma excision ratio was 2.4:1.0; and the melanoma in situ to invasive melanoma ratio was 2.2:1.0. The excision ratios were similar across the 4 centers. The risk of developing a new melanoma was 9.0% annually in the first 2 years and increased with time, particularly for those with multiple primary melanomas. The thicker melanomas (>1-mm Breslow thickness; 7 of 171 melanomas [4.1%]) were mostly desmoplastic or nodular (4 of 7), self-detected (2 of 7), or clinician detected without the aid of TBP (3 of 7). Overall, new melanomas were most likely to be detected by a clinician with the aid of TBP (54 of 171 [31.6%]) followed by digital dermoscopy monitoring (50 of 171 [29.2%]). CONCLUSIONS AND RELEVANCEThe 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.

Etiologies of Melanoma Development and Prevention Measures: A Review of the Current Evidence

“…Using these techniques, detected melanomas are thinner than those found by traditional screening techniques [ 30 , 31 ]. While most studies conducted in order to make screening recommendations were performed only in dermatology clinics, newer data suggest that these surveillance programs can be expanded to additional practices such as primary care skin cancer clinics [ 32 ].…”

Emerging Developments in Management of Melanoma During the COVID-19 Era

“…Data has shown integration of TBP and dermoscopy with telemedicine services ensues a number-needed-to-biopsy (NNB) per one case of melanoma comparable to previously published reports for in-person encounters with dermatologists and physician assistants ( 13 , 14 ). Additionally, prospective results found inclusion of TBP and sequential digital dermoscopy imaging to surveillance protocols aided clinicians in detecting the majority of new lesions in high-risk patients ( 15 ). Moreover, these outcomes are likely to be improved with the integration of artificial intelligence.…”

Surveillance of patients with thin melanoma

“…11 Thus, follow-up schedules for detection of new primary melanoma could be based on patients' individual risk. The follow-up setting can also be based on individual melanoma risk, with patients at higher risk or with atypical mole syndrome followed up in a dermatologic setting or primary care high-risk skin clinic 12 and those at lower risk followed up in primary care or in a shared primary care/specialist care arrangement.…”